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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m o a <br /> APPLICATION FOR - LAND USE - PERMITS m ° <br /> TO THE ZQNING 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 m <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. w d <br /> C o <br /> OWNER DA. J. A. Spitt D TELEPHONE (507) 282-6810 a <br /> d � <br /> ADDRESS 614 MernaAtat aAkwatj RochebteA, MN 55902 <br /> EMERGENCY/FIRE NUMBER .3'� yg ROAD NAME Lee Road <br /> LEGAL DESCRIPTION (see taxrec Ipt) pct. NW 1/4 NE 1/4 Section 26 T40N R15w Town o t <br /> CONTRACTOR JOCkson <br /> t <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n L <br /> SANITARY x PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> _ o < <br /> STRUCTURE/ADDITION USE: SanitaAv Ont o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z <br /> 0 0 <br /> a <br /> m <br /> DIRECTIONS FOR PLOT PLA 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 thew II (W), septic tank (ST),and drainfield (DF). o <br /> 3. Show dimensions in feet oft iefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinarV 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 2 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE L TIONS MUST BE STAKED FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '1I 3 to <br /> PLOT PLAN Z Q <br /> M o <br /> I <br /> I m <br /> SEE ATTACHED 0 <br /> N <br /> ° <br /> I m <br /> n I <br /> Z <br /> l <br /> �I <br /> aM 0aFm <br /> 3 m <br /> m. 9g �nm - M <br /> CONDITIONS OF PERMIT: 9. <br /> Z �' �+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a f01 <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �\\�-� N iw A <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 9J. O 2i a: m <br /> I declare that this application(i cluding any accompanying schedule)has been examined by me and to the best of my knowl- o l <br /> edge and belief it is true,correc and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- : er m m <br /> tion contained in this applicatio (including any accompanying schedule)and I further declare that I recognize that this infor- `� p <br /> mation I am providing will be r lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I S� <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- 4 rn <br /> plication. I agree tc permit cou y officials charged with administering county ordinances or other authorized person to hav <br /> access to the above described remises at any reasonable time for the purpose of inspection. _ [ t m <br /> mo <br /> M pj £A: <br /> SIGN HERE wade Rule otm 5115/94 <br /> (si nature of owner or building contractor) MAY I ud� <br /> ! E E E <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REOUIRD -- o 2 9 9 m <br /> — S 'oS® S ` tA <br /> a <br />