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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 oy <br /> APPLICATION FOR — LAND USE — PERMITS3. o <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and N <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 J <br /> regulations of the State of Wisconsin. �, m <br /> N � <br /> C <br /> d O <br /> OWNER john and Tehe�sa Kend,.icz TELEPHONE (612) 699-3903 <br /> O � <br /> m <br /> ADDRESS 1610 St. C&iA Ave. St. Po-u°, MN 55,105 <br /> EMERGENCY/FIRE NUMBER ROAD NAME St. HGUGf. 77 <br /> 1 <br /> LEGAL DESCRIPTION (seetaxreceipt) Lot 9, CSM Vo,'-. 13, Po. 158, Sec. 24, T41N,, R17W, Town <br /> CONTRACTOR 0�" Swizz 1 rn <br /> �V <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION o <br /> 0 O <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> STRUCTURE/ADDITION USE: SanLtccAy Onlu b.Mh 11W PCD7 <br /> (Y) <br /> (Home/Cabin;Commercial Business;Bedroom; beck:etc.) Z o <br /> 0 0 <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). L 0- <br /> 3. <br /> 3. Show dimensions in feet of thefollowing:(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. 0 !> <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and o -� <br /> dated by the owner. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a N <br /> 11 Z Q <br /> PLOT PLAN ° a <br /> A <br /> j <br /> m a <br /> Cc it ] <br /> m9 <br /> 0 3I <br /> l <br /> o w � <br /> n_ <br /> 0 <br /> SEE ATTACHED <br /> N <br /> o � <br /> � J = <br /> JJ <br /> f <br /> 2am e$ y <br /> CONDITIONS OF PERMIT: m .2 ro <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N: 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 'Noc2i O <br /> ig 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- `+? .°y. : m if i i C <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs- : H a a: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B o <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I b(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- ,p <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O N p <br /> access to the above described premises at any reasonable time for the purpose of ins action. T 3 o X: <br /> CD <br /> SIGN HERE ,� <br /> (signature of owner or building contractor) <br /> FEB t51 <br /> ZONING ADMINISTRATOR V'I <br /> TOWNSHIP PERMITS MAY BE REQUI o�_ m <br />