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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator �, l <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 w o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. <br /> C <br /> OWNER G=! Sem TELEPHONE (7151656-4518 <br /> o <br /> m `E <br /> ADDRESS 7854 County Road F DanbuAy, (VI 54830 — G <br /> EMERGENCY/FIRE NUMBER ROAD NAME MtneAvv. Dam Road �n <br /> 1 <br /> LEGAL DESCRIPTION (seetaxreceipt)pct. NW 9 NE SE, SEC-tion 27, T41N, R1601, Town o6 Stuie.a <br /> CONTRACTOR 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION p <br /> n 7 <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: SanitaAy )nP1 -/ ew )ewi �" J o <br /> o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck; c.) Z v <br /> 0 0 <br /> a <br /> 90 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). 0 <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. 0 ? <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 3 <br /> dated by the owner. 0 0 <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. IN aMilt <br /> N <br /> PLOT PLAN o a <br /> M <br /> P 00 <br /> 0 <br /> In <br /> I � <br /> I N <br /> n <br /> 1 0 <br /> SEE ATTACHED <br /> o y <br /> N <br /> /v Z <br /> t <br /> G <br /> O c�Ei rtDi aim <br /> 0a00 �0 <br /> CONDITIONS OF PERMIT: c 0 y: z c 8 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z 0 o : Q 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P F 0 T rn 77 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> [ i12 m <br /> $� C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- - o 0 � : <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- «m« m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. cit g G <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o`$ o <br /> 0 : <br /> further <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 O o <br /> access to the above described premises at any reasonable time for the purpose of inspection. r 3 $ <br /> : v <br /> /, N <br /> (Dade Rufiano.nm 9/28/93 ^ 0 <br /> SIGN HERE <br /> € <br /> '--- --- <br /> (signs tur of rteIdi ntractop (Yet «S <br /> II ! ) I l?I o z: <br /> ZONING ADMINISTRATOR <br /> { i <br /> OWNSHIP PERMITS MAY BE REQUIRED �� i'(1 EP Z 9 -,. ;3 0 m <br /> I�jy _ o00 00o rA <br />