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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o o <br /> APPLICATION FOR - LAND USE - PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and F <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 <br /> regulations of the State of Wisconsin. "1 <br /> w � <br /> m O <br /> OWNER TELEPHONE o. <br /> ViAgit Re teA o <br /> ADDRESS 8441 IAwin Road 0318 Btoom<ngton, MN 55437 "— <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) 1 (� <br /> 1ac2. G.L. 5, Section 27, T37N, R18W, Town o4 made Lake OQ 1 _ <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> n L) ,U <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> STRUCTURE/ADDITION USE: Sancta U, OWU ° o <br /> m <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z o <br /> a o <br /> m <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). <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. 0 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 cn <br /> c <br /> Z o <br /> PLOT PLAN 0 a <br /> m w <br /> 0 <br /> C <br /> m � <br /> ) <br /> N <br /> J� <br /> 0 I N <br /> O <br /> J <br /> SEE ATTACHED <br /> z <br /> I <br /> l <br /> c y r o a 0 <br /> n 2h @ p_m m <br /> aw 0 <br /> CONDITIONS OF PERMIT: < Z C8 .r'o ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f 0 : : T'z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - to M <br /> �; Ziff i <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r" I mO <br /> g: �B <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- C <br /> o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- i «�m«� m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B g p <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 0� <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- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m ; v 0 <br /> g <br /> SIGN HERE Wade Ru�,� 9/5/93�oYm <br /> (signature of owner or building contractor) (date) �' x <br /> ZONING ADMINISTRATOR <br /> 4 f N N r�j N m <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N O <br /> 0 <br /> m <br /> 00o to) <br />