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Burnett Coulnty 7410 Co. Rd. K, No. 102, Sinn, WI 54672 Office of Zoning Administrator c <br /> APPLICATION FOR — LAND USE — PERMITS m <br /> 0 <br /> 70 THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work desci ibed and � <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme its of the $ <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin, a m° <br /> u o <br /> c <br /> OWNER Alan Kisling TELEPHONE (612)455-0139 <br /> ADDRESS 3363 69 St. E. Inver Grove Heights, MN 55076 <br /> EMERGENCY/FIRE NUMBER ROAD NAME Park Street <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR _ {� <br /> TYPE OF PERMIT(S): DWELLINGIBUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o T7 <br /> SANITARY B PRIVY FILLING/GRADING CAMPING�7ooy'%-' <br /> IT SUBDIVI N o <br /> o <br /> IISTRUCTUREJADDITION USE: Sanita �.ru,lLI( } j,�J'�I��, o ° <br /> (Home/Cabin;Commercial Business; Bedr m;Deck;etc.) Z S <br /> o ° <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) ( -, <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate Nor Ih (N). <br /> 2. Show the location of the well (yi),septic tank (ST),and drainfield (DF). o <br /> 3. Show dimensions Infeet ofthefollowing:(a)bulldingto all lot lines,(b)bulldingto center lino}road,( building <br /> measurement to the ordinary high water mark of lake,stream,or river. G <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED, am o y <br /> = c <br /> PLOT PLAN ° <br /> FL <br /> A o <br /> C p <br /> N <br /> M >�- <br /> SEE ATTACHED <br /> 0 <br /> ° <br /> N <br /> VI <br /> n' <br /> y <br /> w <br /> y IC <br /> Z <br /> ) s <br /> r <br /> f <br /> s A <br /> CONDITIONS OF PERMIT <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN e0 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` �' i '• C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best o my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all infonna- m <br /> tion contained In this application(including any accompanying schedule)and I further declare that I recognize IN t this Infor- i 15 25 '• f7 <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Isau a penult. I . $ $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providin I in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pay ion to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. r <br /> Wade Rufsholin 5/8/95 " . . . . ' <br /> SIGN HERE 40 <br /> (signature of owner, r uild ng III (date) <br /> i <br /> ZONING ADMINISTRATOR g <br /> TOWNSNI ERMITS MAY BE REQUIRED � '�5 <br /> qg 88i$8 a, <br />