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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54072 Office of Zoning Admiral orator 'S o/ <br /> APPLICATION FOR — LAND USE — PERMITS ' <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the o c <br /> Burnett County land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and $ n <br /> regulations of the State of Wisconsin. m <br /> c 4 <br /> OWNER Bryan Bjorklund TELEPHONE (715) 689-2196 s F <br /> ADDRESS P.O. Box 658 Grantsburg, WI 54840 ' <br /> EMERGENCY/FIRE NUMBER ROAD NAME Ice House Bridge Road <br /> LEGAL DESCRIPTION (seetaxreceipt) NE NW, Section 28, T39N, R17W, Town of Lincoln <br /> n <br /> CONTRACTOR n <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> n Q <br /> SANITARY B PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o < <br /> w � <br /> STRUCTURE/ADDITION USE: Sanitary Only O� <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) °z o <br /> 'm <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 (NS) and Indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfleld (DF). <br /> 3. Show dimensions In feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building J <br /> measurement to the ordinary high water mark of lake,stream, or river. <br /> 4. N separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 o m <br /> PLOT PLAN P S <br /> C J <br /> a I <br /> t <br /> Q ch <br /> r <br /> 0 <br /> SEE ATTACHED � <br /> ° I� <br /> 0. <br /> o' <br /> 4 � <br /> 4 <br /> Z <br /> f <br /> CONDITIONS OF PERMIT: ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p °� R :ij <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ' a <br /> 3. NO GRADING OR SHOREIAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. '• Vi ` ? C <br /> C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best o my knowl- <br /> edge and belief it Is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- 9-'t « <br /> O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a hermit. 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 Parton to have p* <br /> access to the above described premises at any reasonable time for the purpose of Inspection. T ¢ <br /> F i <br /> olm 5/8/95 <br /> SIGN HERE Wade Rufsh - ' <br /> (signature of owner or bu din contrac (date) <br /> i <br /> ZONING ADMINISTRATOR ` $$ : '• <br /> TOWNSHIP S MAY E REQUIRED rI ir%Li51 '' ! ''35 <br /> Rig ami <br />