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Bumett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m W� 4 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n 7✓ <br /> regulations of the State of Wisconsin. H m <br /> OWNER SandAct 6 Louxence Webingeh TELEPHONE (612) 490-0883 a <br /> m_ 'D <br /> ADDRESS 1292 Lovtk Avenue Maptewood, MN 55109 <br /> EMERGENCY/FIRE NUMBER ROAD NAME Jamtaon Road <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> Lot 4A, CSM Vol. 1, Pq. 162, G.L. 4, Section 31 , T40N, <br /> CONTRACTOR `t 16(9, Town afy Oa�Zand I <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> O <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION0 <br /> o <_ <br /> STRUCTURE/ADDITION USE: $anitdhV 137C�Lr r s�`"; E; g <br /> (Home/Cabin;Commercial Business;Bedroom: De k;etc.) - Z � <br /> oo <br /> o rn <br /> m `V <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). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). o_ <br /> 3. Show dimensions In feet ofthefollowing:(a) building to all lot lines,(b)buildingto 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. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a cn <br /> c <br /> PLOT PLAN o n <br /> M N <br /> 0 <br /> I <br /> M <br /> -75 <br /> T r <br /> 1 � N <br /> m <br /> SEE ATTACHED ° <br /> N � 1 <br /> J <br /> Q � <br /> N <br /> Z <br /> i x <br /> f <br /> A <br /> m. Dg� 2nyQ0XI <br /> CONDITIONS OF PERMIT: a S. Q CS gro r. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e m o' '12 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. F =1 y 33 <br /> 3, NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowt- o C <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 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i3 <br /> matlon 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 'off o <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap- ' <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have ON o <br /> access to the above described premises at any reasonable time for the purpose of inspection. ' ` 3 0 3i-' <br /> y <br /> SIGN HERE Wade Ru/hhotm <br /> (signature of owner or buildingcon ton i (date) ` <br /> ZONING ADMINISTRATOR `3Er Ji <br /> 1 g <br /> TOWNSHIP RMITS MAY BE REQUIRED N m <br /> . � . 09 , 60 cn <br />