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()o cb ' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m o 0 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 v v o �) <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and $ `7 <br /> regulations of the State of Wisconsin. <br /> m <br /> OWNER Robert Webster TELEPHONE 715-488-2780 <br /> m_ m <br /> ADDRESS 12800 County Rd 0 Grantsburg WI 54840 <br /> EMERGENCY/FIRE NUMBER 12800 ROAD NAME County Rd 0 dv <br /> LEGAL DESCRIPTION (see tax receipt) 5 acre pcl in SE'/4SW/4 S18 T37N R18W oil- <br /> CONTRACTOR <br /> Daniels Plumbing & Heating Inc 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> o <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> 0 .. <br /> family h ^ <br /> STRUCTURE/ADDITION USE: Single y oma s q <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> 0 0 <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). v <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)building to center line of road,( )bulltling <br /> measurement to the ordinary high water mark of lake, stream, or river. II-- <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 n <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. c N V <br /> PLOT PLAN <br /> A ` o <br /> N. U <br /> C , <br /> a , <br /> fn <br /> SEE STATE APPROVED PLAN / <br /> r <br /> Z <br /> N <br /> O <br /> N <br /> O <br /> O <br /> O � <br /> N <br /> A <br /> I <br /> c Y <br /> G <br /> CONDITIONS OF PERMIT: a m ff <br /> C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a �Z =12. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. rn m <br /> 1 declare that This application(including any accompanying schedule)nes been examined b me and to the best of - <br /> E . C <br /> Y Y knowl- , <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of a 1 informs. m •"� <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- -� v 8 g 14 m M <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue Ipermit. I g� $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing n this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized para n to have <br /> access to the above described promises at any reasonable time for the purpose of inspection. <br /> 3 <br /> u <br /> N . m <br /> SIGN HERE 6/19/95 i <br /> (signature of owner or puilding c�ontr (date) <br /> ZONING ADMINISTRATOR <br /> rwww a <br /> TOWNSHIP PERMITS MAY BE REQUIRED �""'+ 't <br /> w' 31 iTl FS,�' i); ,�'35 rtt <br /> 88888888H <br />