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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR — LAND USE — PERMITS - <br /> TO THE ZONING ADMINISTRATOR: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 <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and C <br /> regulations of the State of Wisconsin. m <br /> w � <br /> , O <br /> OWNERClark Jewell TELEPHONE (715)349-5400 £ <br /> ' <br /> m / m <br /> 0 <br /> ADDRESS 9651 County Road D Webster, WI 54893 <br /> EMERGENCY/FIRE NUMBER 9651 ROAD NAME County Road Di <br /> r <br /> LEGAL DESCRIPTION (seetaxreceipt) pel. NE WN, Section 33, T39N, R17W, Town of Lincoln 61 <br /> 7T <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ADDITION p rO <br /> n !7 <br /> SANITARY % PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o a <br /> ' - I <br /> STRUCTURE/ADDITION USE: <br /> Sanitary Only ° = <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z o <br /> 0 v <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). j <br /> 2. Show the location of the well (N),septic tank (ST),and dralnfield (DF). S <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c building 11 d <br /> measurement to the ordinary high water mark of lake,stream,or river. C <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. C) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE SSUED. 11 o N <br /> Z o <br /> PLOT PLAN <br /> � Q N <br /> o' <br /> a <br /> fn V <br /> X_ I�w <br /> SEE ATTACHED Q <br /> J � <br /> "s <br /> I� <br /> - vJ <br /> O y <br /> w <br /> r <br /> G Z <br /> L <br /> N <br /> In <br /> 330 Z: � C g-' <br /> CONDITIONS OF PERMIT: Z Q C `$ N's ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. u IA i 142 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. S2 M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` r" i dig ? m <br /> 10 <br /> es e <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best o my knowl. C" <br /> edge and belief it Is true,correct and complete.1 acknowledge that 1 am responsible for the detail and accuracy of all informs- I a to: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize ih t this Infor- `. <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I f'• E $ $ <br /> further accept all liability which maybe 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 <br /> access to the above described promisee at any reseonablo time for the purpose of Inspection. T <br /> �i <br /> Wade Rufsholm 4 " ` . . . <br /> SIGN HERE <br /> lnJ77a <br /> (signature Of OWMr or tolldlOQ COmtr O <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED NOV i d 1994 X i $ m <br /> 98 9888fmn <br />