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Burnett County 74 to Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rn U1.1 <br /> 0 <br /> APPLICATION FOR - LAND USE - PERMITS : F <br /> TO THIE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the c <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ o <br /> regulations of the State of Wisconsin. <br /> c o <br /> O <br /> OWNERREN Luke TELEPHONE (715)689-2296 0 0 <br /> m <br /> ADDRESS 11097 Crosstown Rd. Grantsburg, W1 54840 <br /> EMERGENCY/FIRE NUMBER 11097 ROAD NAME Crosstown Road <br /> LEGAL DESCRIPTION (see tax receipt) NE NE, Section 26, T38N, R18W, Town of Wood River ) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> 0 <br /> SANITARY % PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o °<_ <br /> 0 <br /> � r <br /> STRUCTURE/ADDITION USE: Sanitary Only o <br /> v <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) o d <br /> 0 <br /> } <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 dralnfield (DF). ) 4 <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building O � <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. Q <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 3 <br /> as PLOT PLAN C ' S <br /> m IC g (� <br /> M ' <br /> 111 <br /> 9, <br /> 1 <br /> SEE ATTACHED I(�� <br /> o I`Y <br /> o' <br /> v � <br /> w <br /> 2 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p E 'Z <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. <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- E , <br /> edge and belie it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this Infor- i IS <br /> mation I 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 ap. <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to haw <br /> access to the above described Pnmises at any reasonable time for the purpose of Inspection. T <br /> i <br /> Wade Rufsholm 11/21/94 <br /> SIGN HEREdate) - <br /> (signature of o nor r b It i tractor) <br /> v ADMINISTRATOR ` ' $ `• ' <br /> ti�`? TO NSNIP PERMITS MAY BE REQUIRED <br />