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Burnett County,7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator N m o o <br /> APPLICATION FOR — LAND USE — PERMITS s' <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit fa the work described and m c 8 <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 Courcy Ordinances and the laws and <br /> regulations of the State of Wisconsin. w m <br /> 4 et <br /> OWNER Charlie Moen TELEPHONE O <br /> O � � <br /> ADDRESS Bog 237 Webster, WI 54893 <br /> EMERGENCY/FIRE NUMBER ROAD NAME Helsene Road <br /> LEGAL DESCRIPTION (see tax receipt) pcl. NE SW, Section 12, T3911, R17W, Town of Lincoln G <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ADDITION o <br /> � O <br /> SANITARY % PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o < (� <br /> 0 <br /> r <br /> STRUCTURE/ADDITION USE: Sanita�ly o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) z 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 dralnfleld (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 IS' <br /> measurement to the ordinary high water mark of lake,stream,or river. Ir <br /> 4. N separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAN=D FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. IN 3 N <br /> Z o <br /> PLOT PLAN o n <br /> Q o <br /> C <br /> Vq <br /> 4i <br /> I7 <br /> mNm <br /> I n <br /> O <br /> SEE ATTACHED o <br /> O y <br /> w rn' <br /> I <br /> Z <br /> m <br /> CONDITIONS OF PERMIT: 3" z '� g IC <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E E Zil <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. E N• i M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` L'i O m0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. i <br /> edge and belief it is true,correct and complete.I 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 I recognize that this Infor- : '. E O <br /> matlon 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 have <br /> access to the above described premien at any reasonable time for the purpose of inspection. m <br /> SIGN MERE Wade Rufsholm 8 <br /> Mi <br /> (signature of owner or puilding contractor - Nell <br /> ZONING ADMINISTRATOR I O IMz - $ <br /> TOWNSHIP PERMITS MAY BE REQUIRED `ti.. ` 8 8 8�8 8,8» m <br /> 5 <br /> 'V• 8 CA <br />