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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 <br /> Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS . _TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the require Ms of the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and t laws and <br /> regulations of the State of Wisconsin. = o <br /> w m_ <br /> OWNERRobert Mann TELEPHONE 715-866-4379 n r £ <br /> 1 � <br /> ADDRESS 8245 Park St W Danbury WI 54830 " _ <br /> EMERGENCY/FIRE NUMBER <br /> 8245 ROAD NAME park St W <br /> LEGAL DESCRIPTION (see tax receipt) GL 1 S25 T40N R 17W <br /> CONTRACTOR <br /> Daniels Pllunbi & Heati Inc n <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION \\ <br /> o <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o <br /> w <br /> STRUCTURE/ADDITION USE: o g <br /> (Home/Cabin;Come"Irnow home <br /> mercial Business;Bedroom; Deck;etc.) _ 'a <br /> 0 0 <br /> 0 <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 drainfieid (DF). o <br /> 3. Show dimensions In feet of the following:(a) building to all lot lines,(b)bullding to center line of road,( )building I(� <br /> measurement to the ordinary high water mark of lake,stream,or river. I�h'n' <br /> B s <br /> 4. separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and X <br /> dated by the owner. O 0 <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. ON c <br /> n <br /> PLOT PLAN z `v <br /> P n <br /> A � 3 <br /> M o <br /> c <br /> to .c <br /> See attached III <br /> r <br /> N <br /> m <br /> n <br /> O <br /> O �, F <br /> 0 V <br /> m <br /> O � <br /> N <br /> ^L <br /> 0 <br /> V Z <br /> i <br /> F <br /> CONDITIONS OF PERMIT: c $g C, g 33 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F :` 9 Q -•1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMRTED. t'n E ' O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of ny knowl- = C <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of a informs- . •"m°' m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- �' d 8 '. 0 <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue i permit. I ; gr$ $ i <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing n this ap• <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized perst n to have o <br /> access t0 the above described promises at any reasonable time for the purpose Of inspection. <br /> SIGN MERE 5/24/95 <br /> rA <br /> (signature of own o bu dl t oq (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED rr.�j -, m <br /> 'a��� � 4X 'X �$ m <br />