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Burnett CouAty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m/ �o V O , <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m d <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v m <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 <br /> regulations of the State of Wisconsin. w m <br /> wm <br /> C � O <br /> OWNER Karen Bnandt TELEPHONE (715) 349-5799 m A <br /> ADDRESS P.O. BOX 7 EhedeAic, WI 54837 `" r <br /> ri <br /> EMERGENCY/FIRE NUMBER ROADNAME County Line Road ...� <br /> LEGAL DESCRIPTION (seetaxreceipt) SE SE Section 32, T38N, R17W, Torun ob Danie z l� � <br /> CONTRACTOR _ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> 8 C) - ) <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION O <br /> o �. <br /> STRUCTURE/ADDITION USE: Sani,taLy Onty minG P"'a j f t&,C °^ <br /> (Home/Cabin;Commercial Business; m;Deck;etc.) T Z o <br /> O Q <br /> w <br /> — 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) oc <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). x <br /> 2. Show the location of the well (W),septic tank (ST),and dralnf laid (DF). C <br /> 3. Show dimensions In feet of thefollowing:(a)building to 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 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAID FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I v v, <br /> PLOT PLAN <br /> C w <br /> O <br /> 1 , <br /> I� <br /> Lu <br /> I <br /> I <br /> d .< <br /> �J m <br /> 0 <br /> SEE ATTACHED ' <br /> o <br /> m' <br /> O ,y <br /> a <br /> Z <br /> / n <br /> A g2n a <br /> CONDITIONS OF PERMIT: = g : .2 C o z m' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 'v E y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. fn D i m <br /> 1 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- m <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 permit. 1 8$ 8 <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 <br /> access to the above described premises at any reasonable time for the purpose of Inspection. : '• g <br /> T <br /> SIGN HERE Wade RuUzhoim 4/4/93 a ' <br /> (signature of owner or bu 1 c at $ a <br /> it: <br /> E <br /> ZONING ADMINISTRATOR T <br /> TOWNSHIP RMITS MAY BE REQUIRED �d o o nt <br /> $8 \J 8 8 8 ori <br /> a <br />