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06 ctm p <br /> att Courtly 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator W m o O <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d o <br /> HE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 <br /> ted 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 n <br /> regulations of the State of Wisconsin. - <br /> m m <br /> N � <br /> C <br /> OWNER Rob✓ct MeyeA 8 LaAAy LaAaan TELEPHONE (612) 426-4318 a o <br /> oOi m <br /> ADDRESS 4721 ShaA on Lane White Bean Lc,ee, MN 55110 m <br /> EMERGENCY/FIRE NUMBER 3547 ROAD NAME Rigby Road I <br /> LEGAL DESCRIPTION (seetaxreceipt) Lot 3, CSM Vot. 10, Pg. 35, Section 13, T40N, R15(r), <br /> I <br /> CONTRACTOR Town o6 Jack-son ,9 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> 47 <br /> SANITARY x PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 <br /> H � <br /> 0 <br /> STRUCTURE/ADDITION USE: SanitaAy OnEV 1 <br /> m <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z o <br /> o � <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). .� U� <br /> 2. Show the location of the well (W), septic tank (ST), and drainfield (DF). C' <br /> 3. Show dimensions in feet ofthefollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building -q I _ <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 <br /> dated by the owner. C o <br /> NOTE'. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a w <br /> 9I Z `v <br /> PLOT PLAN 9 a <br /> M o <br /> m <br /> w - <br /> SEE ATTACHED W <br /> o y <br /> N <br /> Z <br /> 9 <br /> I 'v)ry111 <br /> C 1 <br /> G <br /> m O C <3 P1 m O O-� InIn <br /> m `G 2 C1. m Q m M <br /> O m<.: (=m O <br /> CONDITIONS OF PERMIT: < m Q T �' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f o -Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =y' M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. !" O m <br /> o a� : 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 informa- «m n: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. of o ; p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I Vjo o <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.1 agree to permit county officials charged with administering county ordinances or other authorized person to have O N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. T 3 $ <br /> _ ? V A N <br /> m A . <br /> 69ade Ra�hhaan 9128193 <br /> SIGN HERE «' <br /> (signature of own o uil 'n co r tor) I (date) <br /> o : <br /> ZONING ADMINISTRATOR <br /> d« « ««« T <br /> TOW NIP PERMITS MAY BE REOUIRED o u N 60o0N $ m <br /> 000oora <br />