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60 C&q- <br /> Burnett County 7410 Co. Fid. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 m c a <br /> APPLICATION FOR — LAND USE — PERMITS 3. ' _ <br /> m o <br /> TO THE ZONING ADMINISTRAT R:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 3 <br /> Burnett County Land Use Ordine ice,Sanitation Code, and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisco isin. m <br /> m <br /> m o <br /> OWNER Jim EAickbon TELEPHONE (612)424-4322 c �� <br /> ADDRESS 12962 73Rd Ptaae No)tth Map& GAove, MN 55369 <br /> EMERGENCY/FIRE NUMBER ROAD NAME St. HWy. 77 <br /> LEGAL DESCRIPTION (see tax race'Pt) Lot CSM Vo.P. 13, Pg. 156, SeC-tion 1 1 24p,��� �IJT41N, RI , �y <br /> CONTRACTOR <br /> Town o{ OIN-Il � <br /> n <br /> TYPE OF PERMIT(S): DWELLING/ UILDING—X— GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> n L1 <br /> SANITARY x PRIVY FILLING/GRADING CAMPING UNjT SUBDIVISION � o 0 <br /> r <br /> STRUCTURE/ADDITION USE: Sant-taA.f.1 +nff yv ° <br /> (Home/Cabin;Commercial Business; Bedroo ;Deck;etc.) Z o <br /> m <br /> DIRECTIONS FOR PLOT PLA 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 thew II (W),septic tank (ST), and drainfield (DF). .� <br /> 3. Show dimensions In feet oft iefollowing:(a) building to all lot lines,(b)building to center line of road,(c)building (Xj <br /> measurement to the ordinary high water mark of lake, stream, or river. OC <br /> 4. If separate plans are submited by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. C o <br /> 29 <br /> NOTE: BUILDING/STRUCTURE LO TIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o rn <br /> 11 z Q <br /> PLOT PLAN o n <br /> n <_: <br /> fAU o <br /> m 4:_ <br /> UM <br /> 0 <br /> SEE ATTACHED o <br /> N � <br /> I <br /> G <br /> m O,cpp C�05 as * m <br /> m. pn 2y e = M <br /> CONDITIONS OF PERMIT: < 301, CS a m- <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 9� <br /> 2. REMOVAL OR CUTTING C F TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =f°' <br /> NN' <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 62m o : Bop 0 <br /> JL <br /> I declare that this application(i icluding any accompanying schedule)has been examined by me and to the best of my knowl. o i C <br /> edge and belief it is true,correc t and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- i •^w m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i 8 @ p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $`8 <br /> further accept all liability whict may be a result of the County of Burnett relying on this information I am providing in this ap- („ <br /> plication.1 agree to permit courity officials charged with administering county ordinances or other authorized person to have ro N m <br /> access to the above described premises at any reasonable time for the purpose of inspection. T : v $ - <br /> SIGN HERE wade Ru zhotm <br /> (si nature of owner or building contractor) (date) <br /> :m Fl <br /> ZONING ADMINISTRATOR ' ' 8 : x <br /> . pp <br /> ` HN N� N1001 n <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> P m vn m <br /> O <br />