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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m — <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. �, m <br /> a o <br /> OWNER TeAAy Be.Ela.2e TELEPHONE (715)248-3952 ° f <br /> ADDRESS 2772JGooA_e Lahe Road New Richmond, WI 54017 <br /> EMERGENCY/FIRE NUMBER ROAD NAME Jamison Road 6� 1 <br /> 1 <br /> LEGAL DESCRIPTION (seetaxreceipt) pct. G.L. 1 , Section 6, T39N,R16W, Town o(; Meenon --. <br /> l <br /> CONTRACTOR 101 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION V" o <br /> n G7 <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> STRUCTURE/ADDITION USE: Sani.tahy On& ° � V ' <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z o <br /> 0 0 <br /> _ m <br /> a <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). <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. 0 <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. 0 o <br /> ° � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a N <br /> 11 z <br /> PLOT PLAN q n <br /> M — o <br /> 40 <br /> a <br /> O <br /> SEE ATTACHED <br /> N <br /> N <br /> IV <br /> o <br /> lJ� <br /> Z <br /> 1 � <br /> f <br /> m Mfir.a00 0 em M <br /> CONDITIONS OF PERMIT: $ H' 12 (i . 5 T+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 9 <br /> o £ 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N: M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 'No � 27 2 G <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. - o 'n: 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- " (n m a <br /> O M <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- is o p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $� $ <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 O o <br /> access to the above described promises at any reasonable time for the purpose of inspection. T . 3 <br /> OR <br /> - ...0. O N <br /> Wade Ru.Xjahoem o , [ <br /> SIGN HERE <br /> (signature o e ug <br /> ZONING ADMINISTRATOR -I E <br /> tnT <br /> NSHIP PERMITS MAY BE REQUIRED �i ! N 8 N m <br /> uu g $ SM <br />