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Bumett County 7410 Co Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator `(n 1 o <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> d ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <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 Courtly Ordinances and the laws and 3 <br /> regulations of the State of Wis onsin. m u° <br /> m m <br /> C <br /> m O <br /> OWNER KU)tt and Diane 0.6tbij TELEPHONE <br /> ADDRESS 1230 Dwane StAeet South St. Paut, MN 55109 —" <br /> r <br /> EMERGENCY/FIRE NUMBER P9753 ROADNAME E".5t Yettow Rivm Road <br /> LEGAL DESCRIPTION (seetaxr ceiPt) tot 12 CSM V. 11 , Pg. 286, Section 7, T40N, R16W, 9 <br /> CONTRACTOR Town o{ Oaktnd <br /> TYPE OF PERMIT(S): DWELLING/131-111—DING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> o O <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo 0 <br /> O <br /> STRUCTURE/ADDITION USE: t o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Zo <br /> o ° <br /> D <br /> DIRECTIONS FOR PLOT PI-AN DRAWING: (Aerial or top view) ` <br /> 1. Show the location and sl Ee 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 ofthefollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordinary high water mark of lake,stream, or river. Q <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. _ Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a to <br /> 11 .Z cv <br /> PLOT PLAN ° a <br /> A � <br /> C <br /> Z <br /> I �1 <br /> c <br /> i <br /> N <br /> — m <br /> n <br /> SEL ATTACHED o <br /> N <br /> O CQ <br /> O <br /> 0 � <br /> w <br /> 2 <br /> 1) <br /> �c��imcDi a0M <br /> m —a� a m Q m y <br /> CONDITIONS OF PERMIT: <br /> '^ my.: zc80 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a F 5 TQ : : 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =r» <br /> 2 m <br /> 3. NO GRADING OR SHO ELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED, o i O <br /> I 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- ur m a: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. B o ; p <br /> mation 1 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 whi h maybe a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication. I agree to permit cc unty officials charged with administering county ordinances or other authorized person to havei O m o <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 o m <br /> v Q m <br /> SIGN HERE <br /> Ula e RuAshotm 4/18/94 '" mo € <br /> ignature f owner or building contractor) (date) <br /> ZONING ADMINISTRATOR - a <br /> HHS a`nwu 'n <br /> TOWNSHIP PERMITS MAY BE REOUIRED o $ m m <br /> $ $ $ $$ $ $ vi <br />