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v 5ccp5io , <br /> Burnett County.T410 Co. 11d. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m c o <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <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 Ordin ince, Sanitation Code, and with all other applicable County Ordinances and the laws and n �� <br /> 1 <br /> regulations of the State of Wisconsin. <br /> _ w m <br /> m O <br /> OWNER Rogers Wood TELEPHONE 1715 689-2327 0 - � <br /> m ' <br /> ADDRESS Box 22589 Litt e Wood Lake Road Ghant�sbLvcg, WT 54840 - <br /> EMERGENCY/FIRE NUMBER 22589 Littte Wood Lake Pk)bR, 1AME _r ro <br /> 1 <br /> LEGAL DESCRIPTION (see tax rec ipt) N 712 N 112 SE 1/4 Section 35, T38% R18W, Town of so <br /> CONTRACTOR Wood Riven <br /> TYPE OF PERMIT(S): DWELLING BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION - O <br /> SANITARY x PRIVYo FILLING/GRADING CAMPING UNIT SUBDIVISION o � <br /> r <br /> STRUCTURE/ADDITION USE: Sanitc.AC On& ° o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z 0 <br /> o � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 1(11� <br /> t�.T1. Show the location and siz of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the ell (W),septic tank (ST),and drainfield (DF). 8 <br /> 3. Show dimensions in feet of hefollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building <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 X r <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 -o m Z- <br /> PLOT PLAN Z <br /> o n <br /> C <br /> > <br /> I <br /> C <br /> 5 <br /> SEE ATTACHED <br /> N <br /> n � 1� <br /> 2 <br /> f <br /> O,c Pi D4 <br /> § f m <br /> CONDITIONS OF PERMIT: ^ < �': Z �' 3 ro <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z a ,R <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o £ ' =W : M <br /> w: <br /> 3. NO GRADING OR SHOR LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o � f7 2 i":): 0 <br /> I declare that this application(ncluding any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,torr t and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- H y m <br /> lion contained in this applicati 3n(including any accompanying schedule)and I further declare that I recognize that this infor- - i 5 _ p <br /> motion 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 whit may be a result of the County of Burnett relying on this information I am providing in this ap- N " <br /> plication.I agree to permit COL my officials charged with administering county ordinances or other authorized person to have ii O <br /> access to the above describec premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> 4121194 <br /> is g r of owner or building contractor) (date) '. $ z^i <br /> Oi <br /> ZONING ADMINISTRATOR g k <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 m <br /> $ It fn <br /> 0 <br />