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(-) i (,,6 <br /> Burnett Courtty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 0 o / o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c o <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 County Ordinances and the laws and 3 & _ pp <br /> regulations of the State of Wisconsin. <br /> n <br /> OWNER Rudolph Melin TELEPHONE 715-648-5413 a £ <br /> ADDRESS <br /> 2927 230th St Grantsburg WI 54840 <br /> EMERGENCY/FIRE NUMBER 2927 ROAD NAME 230th A <br /> c <br /> • <br /> LEGAL DESCRIPTION (see tax receipt) SWY4SWY4 S32 T37N R18W <br /> CONTRACTOR Donald Daniels °� 3 <br /> N <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n O <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> 0 — <br /> STRUCTURE/ADDITION USE: d. 171 �1/f l J 4 o ° <br /> (Home/Cabin;Commercial Business;Bedroom; eck;etc.) Z <br /> 0 ° <br /> a <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) Com ` <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). 8 <br /> 2. Show the location of the well (W), septic tank (ST), and dreinfield (DF). I- <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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M i m <br /> dated by the owner. 0 0 <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a h <br /> PLOT PLAN n .0 o n <br /> rn h <br /> Lri <br /> cI 3 <br /> 0 <br /> See State approved plan m w <br /> 013 CD <br /> c+ <br /> 1 <br /> m <br /> I � <br /> n <br /> 0 <br /> L� <br /> o <br /> o <br /> N <br /> Z <br /> X <br /> C <br /> (n (nV (nrDDO U <br /> ° C , > > � 4 m <br /> M <br /> CONDITIONS OF PERMIT: H .2 o ,;; C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F i TQ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = r^ I m <br /> 3, NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r' i m C <br /> c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o i 1° `� m <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informa- 4n m v, 0 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor i i$ N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 8 m 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information i am providing in this so-- <br /> plication. <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have ln0 a p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE e <br /> (signature of owner orb Id' co frac II (date) [ s <br /> i <br /> ZONING ADMINISTRATOR <br /> TOWNSH PERMITS MAY BE REQUIRED <br /> m <br /> , <br /> -- � 8 8888 (mn <br />