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BUMOU County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator (a c c <br /> APPLICATION FOR - LAND USE - PERMITS 5 - _ <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work clesci ibed and a <br /> located as shown herein. The undersigned agrees 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 Count)Ordinances and the laws and $ <br /> regulations of the State of Wisconsin. w m V <br /> 4 O <br /> C <br /> OWNER Robert or Darlyne Gustafson TELEPHONE (715)656-3123 $ E <br /> TVay m '� <br /> ADDRESS 10151 Cutler Road nbu Vu= _5qg�3o o <br /> EMERGENCY/FIRE NUMBER 10151 ROAD NAME Cutler Road <br /> I <br /> LEGAL DESCRIPTION (see tax receipt)NE SE, Section 30, T40N, R17W, Town of Union (N <br /> 1 <br /> CONTRACTOR 7 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY R PRIVY FILLING/GRADINGCAMPING UNIT SUBDIVISION o <br /> o <br /> r <br /> STRUCTURE/ADDITION USE: Sanitary 1P g g <br /> (Home/Cabin;Commerci r Business;Bedroom; ck;etc.) Z <br /> 0 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 Nor It (N). N <br /> 2. Show the location of the well (N),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c building III( ' <br /> measurement to the ordinary 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 sl Ined and <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE SSLIED. 7I 3 N <br /> PLOT PLAN Z <br /> � o n <br /> M <br /> N <br /> (0 .L s <br /> Ic <br /> C's <br /> G a <br /> SEE ATTACHED I <br /> 0 <br /> e I� <br /> m <br /> G <br /> � y <br /> N <br /> I� <br /> Z <br /> r-jm <br /> g-- 311 <br /> CONDITIONS OF PERMIT: 2 ,Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F E 8� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. re ' m0 <br /> I declare that this application(including any accompanyingschedule has been examined b me and to the best ofknowl- <br /> edge <br /> '• C <br /> 1 y Y knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of a 1 informs- f « « <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor• m <br /> motion 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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> n <br /> SIGN HERE Wade Rufsholm 4/1/95 " '• p <br /> (signature of owner II g t (date) « <br /> ZONING ADMINISTRATOR <br /> «r«� T <br /> TOWNSHIP PERMITS MAY BE REQUIRED $ In <br /> In <br /> i <br /> �8 8888 a <br />