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�1U�_ Tf ") <br /> Burnett Co my 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d o o <br /> APPLICATION FOR - LAND USE - PERMITS . <br /> w ° <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 3 a <br /> regulations of the State of Wisconsin. y v <br /> W <br /> C <br /> OWNER G1hizpn ng Pinez TELEPHONE (71 5) 327-8148 a <br /> v � <br /> w <br /> ADDRESS 11050 (t1hispeA ng Pinez Road FnedeAic, W1 54837 � <br /> EMERGENCY/FIRE NUMBER 11050 ROAD NAME Whilsp",ing Pine/s Road C- �— <br /> LEGAL DESCRIPTION (see tax receipt) <br /> SF 1/4 SF 1/4, Section 11, T37N, R18G1, 'rxade Lake <br /> CONTRACTOR oWn1s tp I CO <br /> —1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY X PRIVY FILLING/GRADING CAMPING U SUBDIVISION <br /> 0 o <br /> STRUCTURE/ADDITION USE: SanitaA y Only �&/d;oo UNIT <br /> 62 a 01 <br /> (Home/Cabin;Commercial B iness;Bedroo , Deck;etc.) Z ° <br /> o ° <br /> v <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 (NB) and Indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet of the following:(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. <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11I v <br /> Z Q <br /> PLOT PLAN o a / <br /> M N <br /> NI <br /> M U) <br /> CD <br /> I a <br /> C <br /> 0 <br /> O <br /> O <br /> 7 <br /> N <br /> O <br /> SEE ATTACHED <br /> J <br /> 1 Z <br /> x <br /> o t.- <br /> �m(n10 <br /> CONDITIONS OF PERMIT: Q T , :3 m1. 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. = 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o ' fD `= m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- ' w m v►' a,. <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- °' tNn s <br /> m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 i 8 m 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• w <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have "fn P p ' w � <br /> access to the above described premises at any reasonable time for the purpose of inspection. m g <br /> 3 ,r <br /> M W O . <br /> wade Ru��hatm ,--1-0/26 ,-q <br /> SIGN HERE n <br /> (signature of owner or bu•di con r for <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP ERMITS MAY BE REQUIRED OCT 2 7 I � N N N`��'" <br /> �i PP cnoo8 m <br /> 8 9 9 v <br />