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Burnett County 7410 Co. Fild. K. No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR — LAND USE — PERMITS 5 <br /> m s <br /> TO THE ZONING ADMINISTRA OR:The undersigned hereby makes application for a Permit for the work described and WO <br /> o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the C <br /> Burnett County Land Use Ordirance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. a m O <br /> c <br /> E <br /> OWNER '(Jaye Chan TELEPHONE <br /> o ' <br /> m m <br /> 0 <br /> ADDRESS 584 Lundy Lan Hudson, WI 54016 <br /> EMERGENCY/FIRE NUMBER ROAD NAME West Yettow Rives Road <br /> G <br /> LEGAL DESCRIPTION (seetaxre eipi) Lot 26 Riven Oaks Section 7 T40N R16W Town o <br /> Oakland <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> � o <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` <br /> J <br /> STRUCTUREIADDITION USE: Sant-taA Ont ° <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z o <br /> Io v <br /> F� <br /> DIRECTIONS FOR PLOT PLJ N DRAWING: (Aerial or top view) Q� <br /> 1. Show the location and sh a of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the i fell (Vi),septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions in feet o thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordin try high water mark of lake,stream,or river. <br /> 4. if separate plans are subn ttted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. 0o <br /> NOTE: BUILDING/STRUCTURE I-CCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A o N <br /> 1A Z v <br /> PLOT PLAN 9 <br /> 4 ) n <br /> M ^' o <br /> C <br /> In <br /> ( <br /> O <br /> N <br /> O <br /> SEE ATTACHED <br /> O ti <br /> m <br /> Z <br /> w I� <br /> f <br /> m. aw00 <br /> CONDITIONS OF PERMIT: 'z2 ' ; <br /> i. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E `: S'2 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ^�„i N i m <br /> 3. NO GRADING OR SHO ELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 0 <br /> f � ' t C <br /> I declare foal this application(including any accompanying schedule)has been examined by me and to the best of my knowl- «; A <br /> edge and belief it Is true,cor t and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- `+• , m <br /> tion contained in this applic Ion(Including any accompanying schedule)and I further declare that I recognize that this infor. E $ E p <br /> mation I am providing will felled upon by the County of Burnett Wisconsin in determining whether to issue a permit. I i i3 $ $ <br /> further accept all liability whl In 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 c unty officials charged with administering county ordinances or other authorized person to have ` <br /> access to the above descri premises at any reasonable time for the purpose of inspection. .n <br /> Wade Ru shotm ~ <br /> SIGN HERE <br /> signature of owner or building contractor) <br /> ZONING ADMINISTRATOR " 'm �— • $ ' <br /> w w�NNr. �1 <br /> TOWNSHIP PERMITS MAY BE REOUI 5 i1m <br /> 8 8 8 8 8 8188 a <br /> J <br />