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Burnett County 741QCo. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0) mo 0 <br /> APPLICATION FOR - LAND USE - PERMITS3_ <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 'z « C <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. <br /> E m <br /> E <br /> OWNER NenbeA t Venta TELEPHONE (715)866-8906 a <br /> 4 m <br /> m <br /> ADDRESS 6781 County Road C Danbuhy, (01 54830 m <br /> EMERGENCY/FIRE NUMBER 6751 ROAD NAME County Road C ) <br /> LEGAL DESCRIPTION (seetazreceipt) pc,E. SE NW, Section 22, T40N, R16W, Town o� Oaktand J <br /> CONTRACTOR <br /> t t V <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> - I <br /> n O <br /> SANITARY X <br /> PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a ° <br /> J r. <br /> r <br /> STRUCTURE/ADDITION USE: SanitaAy Oay o °— <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Zo <br /> o <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 the well (W),septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)buildingto center line of road,(c)building .0 <br /> measurement to the ordinary high water mark of lake, stream, or river. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTfE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '1I c w <br /> c <br /> PLOT PLAN o a <br /> C <br /> y <br /> m <br /> I <br /> 0 <br /> S� - <br /> m <br /> 0 <br /> SEE ATTACHED o <br /> o <br /> y <br /> Z <br /> G <br /> M )i ap'.< 2.W m aa:g <br /> —E[. nmq Q m m <br /> CONDITIONS OF PERMIT: <br /> S. <br /> : `Z C m 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 �� ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Sin 6 2 m <br /> o [ aR [ D <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 0; m C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- i • m d' m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- `b' d $ ? p <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue it permit. I o� o <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- y, <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O a O <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 3 <br /> m a A m <br /> m m A <br /> SIGN HERE wade Ru�dhotm 4126193Si <br /> (signature of owner or building contractor) (date) V : i ` <br /> o : x: [ <br /> ZONING ADMINISTRATOR 21 <br /> TOWNSHIP PERMITS MAY BE REQUIRED a N N ro N m <br /> M <br /> 00 000 (/! <br />