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ni &�VTP <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator I '10 -0 0 <br /> APPLICATION FOR — LAND USE — PERMITS ' 3_ 1 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and InH 0 <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 3 n <br /> regulations of the State of Wisconsin. - o <br /> N d <br /> c <br /> OWNER ROdney & Roberta 0130n TELEPHONE 715-635-3998 0 <br /> ADDRESS R-1 1580 Popple Rd Spooner, WI 54801 <br /> EMERGENCY/FIRE NUFd8ER1 Z�nlnr7 District ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> Govt Lot 4; Sec 35 , T39N R16W Town of Meeno <br /> CONTRACTOR .�. <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGElACCESSORY STRUCTURE ADDITION p j" <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNITn O <br /> XY. SUBDIVISION o <br /> o < <br /> N � <br /> STRUCTURE/ADDITION USE: o � <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) Z m <br /> 0 0 <br /> m <br /> O <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)buildingto center line of road,(c)building -1 <br /> measurement to the ordinary high water mark of lake, stream, or river. 0 <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 a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. in o ,n <br /> PLOT PLAN n o n <br /> m N <br /> LAKE g5ft N' <br /> ___ ___.- <br /> fA <br /> I <br /> Nn <br /> YY' , l <br /> N ��f <br /> I 9 0 <br /> w ( <br /> j s , E� 1+e �ri�V = <br /> N 4Q v <br /> � 9 ! <br /> .�� <br /> ROAD <br /> m � (nv(nr DDO � <br /> n ".> > 0of m <br /> M' 7J � 2.aN c = <br /> CONDITIONS OF PERMIT: a S. CS = r. <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. =m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N m <br /> € o : € � o <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o e <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 I recognize that this infor- CKy ,`a B g p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o� e <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 O N o <br /> access to the above descri premises at any reasonable time for the purpose of inspection. w 6 <br /> m -2 <br /> AAo <br /> SIGN HERE r IM ' <br /> (signal a owner or it g contractor) D K _(ditte) i ' <br /> ZONING ADMINIS RATOR 'E $ [ <br /> AP� <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N N <br /> M <br /> o 0000 oo (/f <br />