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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoninq Administrator � m o z <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE'ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work clesci ibed and 'Z a <br /> s <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ w <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. m (T <br /> 4 O <br /> C <br /> OWNER Jim Garfunkel TELEPHONE (715) $ E <br /> o A <br /> m <br /> ADDRESS 6982 Devils Lake Road Webster, WI 54893 m n <br /> EMERGENCY/FIRE NUMBER 6982 ROAD NAME Devils Lake Road <br /> LEGAL DESCRIPTION (see tax receipt) pcl. SW NW, Section 27, T40N, R16W, Town of Oakland Ir <br /> CONTRACTOR 1 <br /> 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION Ia L <br /> m <br /> SANITARY % PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION c e <br /> 0 <br /> STRUCTURE/ADDITION USE: snits P( 0 4 <br /> (Home/Cabin;Commerc 1 Business;Bedroom;Deck;etc.) = v <br /> o ° <br /> a <br /> m <br /> } <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> Vd <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate Norl h (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainf(eld (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 -4 W. <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 1 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. 0 S, <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSU11 ED. 3 y <br /> PLOT PLAN o $ <br /> in <br /> C <br /> w <br /> C ' <br /> a) <br /> M <br /> 0 <br /> SEE ATTACHED IQ� <br /> = J <br /> 9 ma <br /> m <br /> O y <br /> w <br /> Z <br /> S <br /> 1 <br /> CONDITIONS OF PERMIT: o S Z C g ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 0 e e Z Z : Z 1 <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. - rn : ' In <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of <br /> PP (� g Y 1 Y Y knowl- - a f C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of a I informs- `L f « yy!!E m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i' i �'ti 9 G <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue it permit. 1 8$ 8 '. <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 p <br /> access to the above described premises at any reasonable time for the purpose of Inspection. <br /> ,n ru <br /> i <br /> SIGN HERE <br /> Wade Rufsholm 4/3/95 <br /> (signature of owner or bulldln cot to (date) «` <br /> i <br /> ZONING ADMINISTRATOR i 8j <br /> TOWNSN V 11ITS MAY BE REQUIRED m <br />