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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 51072 Office of Zoning Administrator C8 E z <br /> APPLICATION FOR - LAND USE - PERMITS - ' <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 $ <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. v <br /> ick - 63S-�doy g m f <br /> OWNER Bitt Jury TELEPHONE (715)468-7139 -HoM2 o A <br /> 0 <br /> ADDRESS 24755 Paquette Lake Road Spoonen, wI 54801 <br /> J <br /> EMERGENCY/FIRE NUMBER 24755 ROAD NAME Poq uette Lake Road � <br /> LEGAL DESCRIPTION (see tax receipt) Lot 7, Oak PaAk Addition, Section 2, T38N, R14w, 1� <br /> Town o ewey L <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> O <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION °_ <br /> H � <br /> STRUCTURE/ADDITION USE: San{taAN Onty o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 0 a <br /> 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). <br /> 2. Show the location of the well (N),septic tank (ST),and dralnfield (DIF). o <br /> 3. Show dimensions In feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building O <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 M <br /> dated by the owner. C <br /> NOTE: BUILOING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 3 Q <br /> P SI <br /> PLOT PLAN AS. <br /> o <br /> C ' o <br /> IfI o ' <br /> � � I <br /> 1 `C7 <br /> 0 <br /> Q m <br /> O � <br /> SEE ATTACHED °_ <br /> 0 <br /> O � <br /> ICIO, <br /> R'1 Z <br /> , <br /> f <br /> oS� z�"5g C <br /> CONDITIONS OF PERMIT: :f •? - g.Z , 21 <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. N <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. QQ i S <br /> f 5? C <br /> I 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 <br /> true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- p m <br /> Si <br /> lion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this snit. I O <br /> $ $ <br /> malion I am providing will be rolled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. . <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 /> ilhe county l �mhordinances <br /> ther authorized pson to hae <br /> access totabove dearee to dribed premising atany reasonable for the purpose of inspection. <br /> M <br /> SIGN HERE wade Rubahotm <br /> (signature of owMr or building contractor) <br /> ZONING ADMINISTRATOR v JUL �+ <br /> TOWNSHIP PERMITS MAY BE REOUI Vl O ,Wit I � fs m <br /> 88 88,$8iU) <br />