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ccql <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U)� O ' o <br /> APPLICATION FOR - LAND USE - PERMITS 3 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and ,o H <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 0 <br /> regulations of the State of Wisconsin. y <br /> w � <br /> c <br /> m O <br /> OWNER Carrot Titer TELEPHONE X7151635-7363 n <br /> O m <br /> m <br /> ADDRESS 26600 Lagan lane HCR 69 SlaooneA, WI 54801 m <br /> EMERGENCY/FIRE NUMBER 26600 ROAD NAME Logan Lane <br /> LEGAL DESCRIPTION (seetaxreceipt) pCt. SW NW, Vot. 428, Pg. 627, Section 11 , T39N,R14W, � <br /> awn o <br /> CONTRACTOR _ 1 <br /> TYPE OF PERMIT(S); DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION /0j 0 <br /> 0 0 <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo 0 <br /> J <br /> w r <br /> STRUCTURE/ADDITION USE: Sanita ty (]nett ° <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc-) Z <br /> o ° <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 North (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). QO <br /> 3. Show dimensions in feet ofthefollowing:(a) buildingto all lot lines,(b)buildingto centerline of road,(c)building <br /> measurement to the ordinary high water mark of lake, stream, or river. G <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and X <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a ur <br /> PLOT PLAN Z o <br /> � o a n ^ <br /> C (1,1 <br /> I <br /> m - <br /> 1 <br /> ° <br /> 0 <br /> SEE ATTACHED 0 <br /> Z <br /> 1 <br /> i' <br /> 0 bn to v�nr D DOS <br /> cam.> > nnf m <br /> m. 9 �� Em 2 <br /> a2 v m <br /> CONDITIONS OF PERMIT: » .z C8 0 e <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c f 0 `z : 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N 1 M <br /> . ": _ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. !^ : O n : m <br /> g a� C <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o 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- rn y i:: 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 <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 0 <br /> 0 A w <br /> Wade Ru/zho em S <br /> SIGN HERE «,E .8 <br /> (signature of owner oru' i on r tor) �' [ <br /> ZONING ADMINISTRATOR <br /> n wFnywm <br /> TOWNSHW PERMITS MAY BE REO IN N N m <br /> m <br /> 00 <br /> 0oof/1 <br />