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(ti 14)11 SCtrS,, ,c� . <br /> Burrett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS f <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes Q °— <br /> Ig by application for a Permit for the work described and a— <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the o c w <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and j <br /> regulations of the State of Wisconsin. o F <br /> w m <br /> 4 m <br /> C <br /> OWNER Dan Michaels TELEPHONE (715) 327-4510 $ £ <br /> O � <br /> ADDRESS 209 Lakewood Drive Grantsburg, WI 54840 m <br /> 1 <br /> EMERGENCY/FIRE NUMBER 20920 ROAD NAME Lakewood Drive 6/ <br /> rJ l <br /> LEGAL DESCRIPTION (see tax receipt) Lot 1, CSM Vol. 3, Pg. 190, Section 21, T37N, R18111, <br /> Town -of-Trade-1-ake— <br /> CONTRACTOR ?> <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p r <br /> % n o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> �STRUCTURE/ADDITION USE: SanitarycOOMP {)N G <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z a 1W <br /> 0 a 6- <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 dralnfield (DF]. o <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 9 <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 13SUED. 3 rn <br /> PLOT PLAN Z o <br /> � o 0 <br /> o <br /> C r o <br /> , <br /> b <br /> G vil <br /> SEE ATTACH o <br /> m <br /> v � <br /> N <br /> W <br /> 7� J <br /> 7�J Z <br /> j m <br /> CONDITIONS OF PERMIT: o �'z:: Z c g g.� ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a m I : Ic <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. e 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' ` �, m <br /> 1= ; 0 <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of <br /> aPP ( g Y 1 Y Y knows. o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of al informs. � «m « m <br /> tion contained in this application(including any accompanying schedule)and s further declare that 1 recognize that his infor- ? E �' �' : In <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g $ <br /> further accept all liability which may be a result of the County of Burrett relying on this information I am providing In this ap. S <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. pq <br /> -n <br /> Wade Rufsholm 4/10/95 <br /> SIGN HERE <br /> (signaturoo or1 n )Mtor) (date) «' <br /> ZONING ADMINISTRATOR g <br /> TOWNSHIP PERMITS MAY BE REQUIRED « N»'» m <br /> 4i; ', w, f�'i>i''i5 In <br /> 8888i8'$ UP <br />