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BumetCCoanty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator `A(a c <br /> APPLICATION FOR - LAND USE - PERMITS f <br /> TO .THE ZONING ADMINISTRATOR:The tu'ttlersigrletl hereby makes application for a Permit for the work described and Q o <br /> located as shown herein. The underaigned sprees 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. a m <br /> w g <br /> OWNER TELEPHONE c <br /> Orville Dahling (612) 388-9249 m <br /> 0 <br /> ADDRESS 109 Cherry Street Redwing, MN 55066 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 6432 Midtown Road <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n L7 <br /> SANITARY % PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` <br /> o <br /> w � <br /> STRUCTURE/ADDITION USE: Sanitary Only o '— <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) z o <br /> �0 v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) �;;) ` <br /> 1. Show the location and size of all existing buildings (ES) and all new buildings (NB) and Indicate North (N). �"J. <br /> 2. Show the location of the well (W),septic tank(ST), and dralnfleld (DF). o <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. O <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and a <br /> dated by the owner. () 2 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A a ur <br /> c <br /> PLOT PLAN A 0 g <br /> M o I� <br /> M � s <br /> r <br /> m <br /> 0 <br /> SEE ATTACHED <br /> 0 <br /> m <br /> o � <br /> w <br /> Z <br /> 1 n <br /> f <br /> o z:: c 8'- <br /> CONDITIONS OF PERMIT: z. 'z � ?� ; <br />_ 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z !Q ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ^�„, E ; m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O <br /> i diWars that this application(including any accompanying schedule)has been examined by me and to the best of my knowl• E S E <br /> ,,dge ltd belief It Is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- E N r, M: in <br /> R t7 <br /> tion confiotoed In this application(Including any aecompanying schedule)and 1 further declare that I recognize that this Info"- g <br /> motion 1 am ptvodigo will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $ $ <br /> further accept all Ilabafty sthl:ebrney be a"suit of the County of Burnett relying on this information I am providing In this ap- <br /> plication.I agree to permit county offie is charged with administering county ordinances or other authorized person to have ` <br /> access to the above described premleaa,at any reaaonablo time for the purpose of Inspection. ri <br /> i <br /> Wade Rufsholta 1/16/95 <br /> SIGN HERE <br /> (signature of owRa►pp"ta(1� ntr' torr (date) `8 <br /> ')NTNG ADMINISTRATOR �� - $ <br /> TOWNSHIP PERMITS MAY BE REQUIRED Qo !`a�'IfS In <br /> m <br /> 888 88188 v, <br />