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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Admitilstrator ClU L *0 o 0 <br /> APPLICATION FOR — LAND USE — PERMITS - >E <br /> TO—HE ZONING ADMINISTRATOR:The here undersigned 9 by makes application for a Permit for the work des ibed and Q u <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme ms of the o c <br /> Burnett County Land Use Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the Stale of Wisconsin. m ) <br /> OWNER JEFFERY ALBRECHT TELEPHONE 612-926-9901 �f <br /> ADDRESS 4705 SUNNYSIDE RD EDINA MN 55424 m <br /> EMERGENCY/FIRE NUMBER 22848 ROAD NAME JOHNSON RD Ll <br /> I <br /> LEGAL DESCRIPTION (see tau receipt) GL 5 S35 T38N R15W Lot 3 CSM pg 148-'6ol 2 J <br /> I <br /> coNrRAcroR eDANIELS PLUMBING & HEATING INC <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARYX PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> ^ r <br /> STRUCTURE/ADDITION USE: c� ��L�I 1{ 0 o (O <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z v –� S_ <br /> o v G T <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <r� <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 of the following:(a)building to all lot lines,(b)building to center line of road,(c I building (J� <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be at 3ned and M V <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 0 UED. 0 c N <br /> PLOT PLAN Z <br /> o 'n <br /> M w <br /> 0 <br /> 8H9X31A19XARRR®1HNXRKAN C <br /> a G <br /> SEE ATTACHED PLAN M <br /> 1 <br /> V <br /> N <br /> Uv o` <br /> o <br /> m <br /> O y <br /> a <br /> 1 <br /> Z/Yl\v <br /> D <br /> M g' i? <br /> CONDITIONS OF PERMIT: o �3:; ,z c� g� ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> G E 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. r+�' ^ : D <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> QJ ? ' <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- <br /> l <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- m v <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue it 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• i ' <br /> plication. I spree to permit county officials charged with administering county ordinances or other authorized person to have - o <br /> access to the above described promises at any reasonable time for the purpose of inspection. <br /> T <br /> SIGN HERE OJ� 6/6/95 <br /> (signature of owner r building n rac 0 (date) « <br /> -.ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED -f <br /> Fp 4A 4X SS lX fS mi <br /> 88 $ $8 $$ (n <br />