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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Of Has of Zoning Administrator y� m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO TI-E`20NING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a <br /> located as shown herein. The undersigned agrees that all work shall be tlorte 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 $ <br /> regulations of the State of Wisconsin. w m l <br /> u u <br /> c <br /> OWNER Ken Johnson TELEPHONE (715)349-2211 $ <br /> m_ o <br /> ADDRESS P.o. Box 74 Siren, WI 54872 <br /> EMERGENCY/FIRE NUMBER ROAD NAME County Road A <br /> LEGAL DESCRIPTION (see tax receipt) Lot 14, CSM Vol. 5, Pg. 191, Section 28, T40N, R15W, <br /> own ot Jackson <br /> CONTRACTOR ' <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> � L7 <br /> SANITARY % PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo 0 <br /> NNuu II ^I/ , /7 0 <br /> STRUCTURE/ADDITION USE: Sanitary** `'f IVP'l k(,��W.' o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z o <br /> 01� c <br /> w s � <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). 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. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and a <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 91 o y <br /> 11 z o <br /> PLOT PLAN ° I\ <br /> C, o <br /> vo <br /> � s <br /> 0 <br /> m <br /> SEE ATTAC11ED o <br /> N <br /> Z <br /> M <br /> M <br /> ;j FFiiC s <br /> CONDITIONS OF PERMIT: o QQ Z C g I. E <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ` NN- 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best ofmy knowl- '. E <br /> edge and belief It is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of oil informa- }}++ }}±± m <br /> tion contained In this application(including any accompanying schedule)and I further declare that I recognize that this infor. Ei p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue''•permit. 1 E $Y -8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providin�In this ap- <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 <br /> i <br /> Wade Rufsholm 6/12/95 <br /> SIGN HERE r•E [ <br /> (signature of owner or II Ing on t q (date) <br /> ZONING ADMINISTRATOR ' (8 <br /> TOWNSHIPWR ITS MAY BE REQUIRED � i '� m <br /> 19:9 8 8',8!8 mo <br />