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051cony, <br /> Burnett Coynty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator a m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3_ <br /> iu o <br /> TO THE ZONING ADMINISTRA OR:The undersigned hereby makes application for a Permit for the work described and v w <br /> located as shown herein. The ui idersigned agrees that all work shall be done in accordance with the requirements of the ^ L� <br /> Burnett County Land Use Ordin ince,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. — o <br /> N d <br /> N � <br /> C <br /> n 0 <br /> OWNER Daniel Kleinschmidt TELEPHONE <br /> ADDRESS p0 Box 575 Rice Lake WT 54868 <br /> r <br /> EMERGENCY/FIRE NUMBER 70.16 ROADNAME Midtown (� <br /> LEGAL DESCRIPTION (see tax receipt) E/2SWY4SW'/4 S2R T39N R1614 Meenon township h m <br /> CONTRACTOR nonald Daniels <br /> TYPE OF PERMIT(S): DWELLING/ UILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION o <br /> n G) <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o �) <br /> STRUCTURE/ADDITION USE: <br /> Mobile home o <br /> El <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z <br /> a 'o <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 thew II (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet of I he following:(a) building to all lot lines,(b)buildingto 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 submi led by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. 0 0 <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a m <br /> c <br /> PLOT PLAN n _ <br /> m a rnl <br /> See attached CC ul <br /> m - <br /> Fj0 <br /> 0 <br /> N <br /> Z <br /> N <br /> r�rA��r DDoy <br /> m 9g.� 2amy Q:6m <br /> CONDITIONS OF PERMIT: '? m.: ,z C8 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z 0 0 * <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P £ a,N M <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 1-, ut : Q m <br /> 0 : <br /> a2 D <br /> I declare that this application(i icluding any accompanying schedule)nes been examined by me and to the best of my knowl- o: <br /> edge and belief it is true,correc t and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- Fn y rA <br /> Q <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B o p <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 0� o <br /> further accept all liability whict 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 O N o <br /> access to the above described premises at any reasonable time for the purpose of inspecti -;Z:; T ; 3 0 <br /> a <br /> A <br /> M m O <br /> SIGN HER rlQA <br /> (si jnature of owner or building contractor) datet ' 0 ? <br /> ZONING ADMINISTRATOR I C' <br /> �. <br /> to vs`n�rnue,rnT <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N `n N N m <br /> 00000000u) <br />