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eril cu'lle / <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator : 0 o <br /> IE <br /> APPLICATION FOR — LAND USE — PERMITS m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the IC Q <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and VVV <br /> regulations of the State of Wisconsin. m m <br /> c o <br /> O <br /> OWNER Dean Peterson TELEPHONE $ �� <br /> m r m <br /> ADDRESS 715 Woodcrest Drive N. N. Hudson, Wl 54016 <br /> EMERGENCY/FIRE NUMBER ROAD NAME W. Conors Lake Rd. nn <br /> 7, <br /> LEGAL DESCRIPTION (seetaxreceipt) pcl. G.L. 4, Section 35, T40N, R16W, Town of Oakland J —� <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION 1 0 <br /> 0 L1 <br /> SANITARY x PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> i w � <br /> STRUCTURE/ADDITION USE: Sanitary 2yI,.V t <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) z o <br /> IIo c <br /> I } <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 D <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. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 111 o N <br /> c <br /> _ z v <br /> PLOT PLAN A ° <br /> o <br /> a ' <br /> 0 <br /> SEE ATTACHED <br /> 0 <br /> o � <br /> N <br /> ^ I� <br /> 2 <br /> 1 � <br /> I''`mo <br /> C <br /> CONDITIONS OF PERMIT: Z CS <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o I Q <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. ` r" i I a7 25 I m <br /> e : O <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- «o « m <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this Infor. <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $1 $ [ <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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. Tt <br /> i � a <br /> Wade Rufsholm 6/6/95 « w <br /> SIGN HERE ' «' '• <br /> (signature of owner o7filng n r) (data) <br /> ZONING ADMINISTRATOR �� '• <br /> In <br /> TOWNSHIP PERMITS MAY BE REOUIRED 4X i� fS <br /> 8 8 8 8�8�8 rR1n <br />