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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator a m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS3. <br /> d O <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. - <br /> m � <br /> OWNER Kenneth W. Myers TELEPHONE <br /> o ' <br /> m_ 1p <br /> ADDRESS 7626 Hampshire Ave. No. , Brooklyn Park, MN 55428 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 4163 Green Trail (� <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ X ADDITION p <br /> SANITARY PRIFILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> C) <br /> PRIVY <br /> r <br /> STRUCTURE/ADDITION USE: 24' x 321 Garage o 0 <br /> (Home/Cabin;Commercial Business:Bedroom; Deck;etc.) Z <br /> o <br /> D <br /> N <br /> 3 <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 infeet of thefollowing:(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. Q <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on a m <br /> c <br /> PLOT PLAN o a <br /> SEE ATTACHED PLOT PLAN AND VARIANCE #452 m o <br /> C ' <br /> a ' I <br /> m - <br /> 1 <br /> i <br /> � N <br /> m <br /> 0 <br /> 0 <br /> O <br /> b <br /> O <br /> N <br /> — <br /> }rte Z <br /> {/V_1ry111 <br /> C 1 <br /> G <br /> A � c M.w ma a �a <br /> m ja0 am 31 <br /> CONDITIONS OF PERMIT: ? m N. c iS30 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F � :ilz —1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. -Z' <br /> =N M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. .'n m <br /> o : ig E O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o: . . G1 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- m m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor. <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this a <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to thea v ascribed premises at fny reasonable time for the purpose of inspection. T b <br /> � m <br /> SIGN HERE e, <br /> (signature of owner or building contractor) (date) .8 <br /> ZONING ADMINISTRATOR <br /> �. <br /> TOWNSHIP PERMITS MAY BE REOUIRED O Nn UN U" a N 8 m m <br /> 000000000 <br />