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N O&W, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o a <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m o <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 c :TI <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 Ll <br /> regulations of the State of Wisconsin. N m 11 <br /> m <br /> OWNER Max Poole and L. Ann Poole TELEPHONE 259-3406 n <br /> m <br /> ADDRESS 28402 Kilkare Road Danbury, WI 54830 <br /> ..I <br /> EMERGENCY/FIRE NUMBER X8102 ROAD NAME Kilkare <br /> LEGAL DESCRIPTION (see tax receipt)pCl. Volume 490, Pg. 249, Section 13 & 14, T4014, R15W, <br /> own o ac son — <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_X ADDITION o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo °- <br /> ' D <br /> STRUCTURE/ADDITION USE: Gazebo o n <br /> (Home/Cabin:Commercial Business; Bedroom;Deck;etc.) Z a <br /> V <br /> O p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I m <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). r <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 4 <br /> 3. Show dimensions infeet of thefollowing:(a) bulldingto all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordinary high water mark of lake,stream, or river. Q <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,th plans must be signed and <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEIF� RE PERMIT CAN BE ISSUED. on 3 <br /> 71 Z v <br /> PLOT PLAN nL' \ o a <br /> L.mw: L / ttS#� Nr QFf'z a <br /> 5rht No <br /> plus from conte Road <br /> of Kilkare Road <br /> \ m <br /> Pj c,{ToN Oct 12' Gam, , from prope ty <br /> i Cll <br /> btu JgI3 j line �gIIL{p�Fi\) <br /> ' N Y -' <br /> from high 0, p t <br /> water lin <br /> \ Bonner <br /> i \ <br /> a <br /> a , Z <br /> �Pr <br /> a� <br /> Mai i c�Grr�aO � <br /> z <br /> � � ggmm <br /> a�� �awa <br /> CONDIIONS OF PERMIT: ^ < _'= C S � 'C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o 5 -'z –� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =W >7 <br /> m: <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o i a o O <br /> o : off <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 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 informa- " �^w«� T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- J B g : p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap. N <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. T 3 0 R <br /> v <br /> m m > N : <br /> N O : <br /> SIGN HERE <br /> (sign of o r or bulldinq contractor) lfE', <br /> ZONING ADMINISTRATOR "" 7Ldr �- _ g a <br /> TOWNSHIP PERMITS MAY BE REQUIRED �� ' mow H m <br /> moo .U N m <br /> $ $ $ o $ N <br />