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e71 ctyrup , <br /> Burnett County,7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m IM a o <br /> IE <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 70 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 I <br /> regulations of the State of Wisconsin. �, m <br /> w � <br /> c <br /> OWNER KeUy KnutAOn TELEPHONE (715) 792-2299 a <br /> O ,p <br /> ADDRESS W 8009 150th Ave. HageA City, (CJI 54014 m <br /> EMERGENCY/FIRE NUMBER 26029 ROAD NAME East Bash LC-..2e Rood <br /> (J� <br /> LEGAL DESCRIPTION (seetazreceipt) rJC.e. G.L. 4, V.388, Pg. 209, Section 14, T39N, R16W, <br /> CONTRACTOR <br /> Town o6 meeno-ri— <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—� -i— GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n O <br /> SU DIVISION <br /> SANITARY x PRIVY FILLING/GRADING CAMPING UNIT o <br /> o < <br /> STRUCTURE/ADDITION USE: SanitaAa Ontil o a <br /> (Home/Cabin;Commercial Business;)3edroom; Deck;etc.) 0 <br /> o <br /> 9 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top.view) IQ " <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). �1 <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). i? <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building .0 I}� <br /> measurement to the ordinary high water mark of lake,stream, or river. I►NU <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 0 <br /> 0 <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a m <br /> PLOT PLAN n o n <br /> m � o <br /> O W <br /> M <br /> l <br /> U.i <br /> SEE ATTACHED w <br /> 0 <br /> o <br /> O � <br /> N <br /> z <br /> CV <br /> rn <br /> G <br /> CONDITIONS OF PERMIT: <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. -)--: <�n G72 : m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- �^w n: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- $ a o : p <br /> malion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o o <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 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 p <br /> access to the above described premises at any reasonable time for the purpose of inspection. box <br /> m A N <br /> w P o <br /> SIGN HERE .'�000Ie H >l 10/6/93 � .8 <br /> (signature of owner r Ulf Intr 2' <br /> vats)to <br /> ZONING ADMINISTRATOR <br /> n NN W NNrV V m <br /> TOWNS IP PERMITS MAY BE REOUIRED (; -7 o u u w N O gn m <br /> 000 000f/) <br />