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,tett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m a o <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> m o <br /> O THE 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 T C <br /> Burnett Courtly Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> 0 <br /> regulations of the State of Wisconsin. N m <br /> w � <br /> m O <br /> OWNER TELEPHONE (715)327-8222 <br /> Dave AndeAwn d <br /> ADDRESS 1670 Hwy. 48 FAedeAic, NI 54837 <br /> EMERGENCY/FIRE NUMBER ROAD NAME Lift, Lane Q '� <br /> LEGAL DESCRIPTION (seetaxreceipt) v 1 < <br /> Lot 10, P,,aZ a� Gut? Lake, Sec. 2, T4C8, R16(9, Town a� <br /> a, an & Sec. 36, T41P1, R166V, Tawn O,', -SV)/ha <br /> CONTRACTOR �\ <br /> TYPE OF PERMIT . DWELLING/ UILDING_ GARAGE/ACCESSORY STRUCTURE_ ADDITION o <br /> n G7 <br /> SANITARY .� PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o °< <br /> '^ r <br /> fly o a <br /> STRUCTURE/ADDITION USE: faA(z P� '�`^"'( I' �hP <br /> (Home/Cabin;Commercial Business;Bedroom; D k;etc.) Z o <br /> 1 <br /> 0 0 <br /> N � <br /> D <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). J <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). S <br /> 3. Show dimensions infeet ofthefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building Uj <br /> measurement to the ordinary high water mark of lake, stream, or river. Q (A <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 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a N <br /> 1I Z <br /> PLOT PLAN () o <br /> m o <br /> Cl <br /> m Off= <br /> 1 7K, N <br /> m <br /> 0 <br /> SES ATTACHED ` <br /> N <br /> O <br /> J <br /> b <br /> O y <br /> H <br /> I <br /> Z <br /> C <br /> R N tai a: m <br /> CONDITIONS OF PERMIT: ? m N. Q C S 2 m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 �� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _^� I <br /> a. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o <br /> 1 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.1 acknowledge that I am responsible for the detail and accuracy of all informs '^m i+' T <br /> ''ion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infon a o : O <br /> stion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 oo <br /> `her accept all liability which may be a result of the County of Burnett relying on this information I am providing In this a - d, <br /> tion.I agree to permit county officials charged with administering county ordinances or other authorized person to have O o: <br /> s to the above described premises at any reasonable time for the purpose of inspection. T 3 i; <br /> RL <br /> m : b n N <br /> QI 1 <br /> E Glade Ru/aha°M 10/13/43 <br /> (signature of owner or it - g recto (date) <br /> IISTRATOR g ' E i <br /> � � fn .nwwFn <br /> TOWNSHI PERMITS MAY BE REQUIRED <br /> 0 o g o o 0 <br />