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It County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ­ 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v u <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n --:s <br /> regulations of the State of Wisconsin. a m <br /> c m <br /> a O <br /> OWNER Date LaA Son TELEPHONE o. <br /> o m <br /> ADDRESS 2135 Dnaaeh Avenue St. Paut, Mn 55175 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (seetaxreceipt) SE 1/4 SE 1/4, Sec. 79, T40N, R74W, Town 06 Scott <br /> CONTRACTOR Jj <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ADDITION o Z$ <br /> 0 T <br /> SANITARY X PRIVY FILLING/GRADING CAMPING,UNIT SUBDIVISIO o °< U <br /> STRUCTURE/ADDITION USE: .an � rlrU UVI,ZU AJ�CVl1�-� E.f,'f1�li o <br /> (Home/Cabin;Commercialbusiness;Bedroom; Deck;etc.) 0 0 <br /> P 0 "F <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 North (N). o <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building {� <br /> measurement to the ordinary high water mark of lake,stream, or river. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. C o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I3 <br /> 7I z o- <br /> PLOT PLAN A o n <br /> me o <br /> 0 <br /> N <br /> m <br /> � I <br /> n = <br /> SEE ATTACHED o <br /> o <br /> N <br /> r <br /> J G <br /> � Z <br /> S fnN V q� rDDp � <br /> o c a m <br /> o_ a <br /> CONDITIONS OF PERMIT: <. T. : �' m c 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F �� M <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ ^� m <br /> g <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED." i oR a O: <br /> . c C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of 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 informs- » m O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit- I $ 1D $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information i am providing in this ar; <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O u, p <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 3 8 <br /> m m <br /> Wade Rv�h aQm 2/70/93 " <br /> SIGN HERE s <br /> (signature�of owner or building contractor) (date) x <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED »Nn u, o ,'o 8 m <br /> 88 8888ro <br /> i <br />