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64 \ 0 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator N a c 0 <br /> APPLICATION FOR - LAND USE - PERMITS m <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 $ r� <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. a m S <br /> w 0 <br /> OWNER Bob Carlson TELEPHONE (715)866-8293 i f <br /> ADDRESS 27866 Robey Road Webster, WI 54893 <br /> EMERGENCY/FIRE NUMBER ROAD NAME County Road C <br /> LEGAL DESCRIPTION (see tax receipt) NW NW, Section 22, T40N, R16W, Town of Oakland <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> O <br /> SANITARY R PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISI N o` o I— <br /> w r- <br /> STRUCTURE/ADDITION USE: Sanitary 1 l efml o 2 <br /> (Home/Cabin;Commercie usiness;Bedr m; Deck;etc.) Z o <br /> o v <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). p� <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). g <br /> 3. Show dimensions Infest of the following:(a)building to all lot lines,(b)building to center line of road,(c)building <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. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. It a m <br /> 1A Z a <br /> PLOT PLAN o n <br /> � � o <br /> Z <br /> � s <br /> I to <br /> SEE ATTACHED t) o <br /> o I� <br /> o � <br /> IC <br /> Y <br /> f <br /> m <br /> $� —a <br /> o w31 <br /> IQ <br /> CONDITIONS OF PERMIT: � `Z � g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o 'Z <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. i rn <br /> '• C <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- O` g• <br /> a <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 <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- <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. <br /> ' <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 promises at any reasonable time for the purpose of Inspection. ; •gp. <br /> r-.. : <br /> SIGN HERE Wade Rrfsholm 4 M <br /> (signature of owner or builoing contractor) II Idnel <br /> ZONING ADMINISTRATOR _ 29P, s '�'�/'^`� ' `� I OIr-1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED0:g m <br /> $ UM) <br />