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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> m 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the �^ m <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. m "v <br /> c '? <br /> n O <br /> OWNER TELEPHONE <br /> Duane Bayes (715)273-3184 0 �) <br /> io <br /> ADDRESS 738 S Piety Ellswoth WI 54011 <br /> EMERGENCY/FIRE NUMBER ROADNAME Public Access Road <br /> LEGAL DESCRIPTION (seetazreceipt)pCl. G.L. 1, Section 12, T37N, R18W, Toon of Trade Lake <br /> CONTRACTOR ) <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> $ o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a <br /> m r <br /> STRUCTURE/ADDITION USE: Sanitary Only - o 2 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc-) 0 v 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) LIP <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 (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet ofthefollowing:(a)buildingto 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. Q <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. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 m <br /> 71 z `v <br /> PLOT PLAN9 <br /> Q < <br /> o <br /> C I <br /> w _ <br /> M <br /> I <br /> 1 <br /> n <br /> SEE ATTACHED a <br /> N <br /> O ILyY <br /> Z <br /> C \ <br /> m c�aNi �cDi a0 � <br /> CONDITIONS OF PERMIT: o < m" <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r" In <br /> o : <br /> I declare that lois application(including any accompanying schedule)has been examined by me and to the best of my knowl- o a m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- a <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.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. T 3 0 <br /> Wade Rufsholm 8/24/94 <br /> SIGN HERE (date) <br /> 8 <br /> (signature of owner orb ilOing Contr t r) ( o <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REOUIRED m <br /> 000 N <br /> G <br />