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Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator N� I <br /> APPLICATION FOR — LAND USE — PERMITS s <br /> m <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 o <br /> regulations of the State of Wisconsin, <br /> b a m n <br /> c m <br /> OWNER John and Jennifer Sabatka TELEPHONE (715)259-3107 o f <br /> ADDRESSg <br /> 2e770 Long Lake Road Webb Lake, WI 54830 �1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME Bay Road <br /> LEGAL DESCRIPTION (see tax receipt) G <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> O <br /> SANITARY x PRIVY Al <br /> FILLING/GRADING CAMPING UNIT SUBDIVISION ? �_ �I <br /> w r- <br /> STRUCTURE/ADDITION USE: Sanitary Only o ° <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> 0 0 <br /> a () <br /> a (/ <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 Nort (N). <br /> 2. Show the location of the well (W),septic tank (ST), and dralnfleld (DF). o_ <br /> 3. Show dimensions In feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building -4 +� <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. 1A a q <br /> PLOT PLAN ♦7 9 n r <br /> w <br /> i o <br /> SEE ATTACH i <br /> 0 <br /> o I — <br /> Ir <br /> c' <br /> o � <br /> Nr IIItI�.r� <br /> r I <br /> 2 <br /> am <br /> i m <br /> m aw <br /> CONDITIONS OF PERMIT: Z C g ; <br /> i. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <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. �' pO p <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 true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- Me : m <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize the this infor E $ p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. I $ $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providin in this ap• E i ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pe n to have <br /> access to the above described premises at any reasonable time for the purpose of Inspection. <br /> T i <br /> Wade Rufsholm 6/5/9 « " ' <br /> SIGN HERE ' « <br /> (signature of own o buildng r t (date) r� <br /> 11 E 25 E <br /> ZONING ADMINISTRATOR g ' <br /> TOWNSHFP PERMITS MAY BE REQUIRED 95518 m <br /> 88�88�88 y <br />