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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d A -0 1 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <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 a J <br /> regulations of the State of Wisconsin. o <br /> N � <br /> m O <br /> OWNER Jim E CRA o2 PAat` TELEPHONE n F <br /> m tD <br /> ADDRESS 411 Junip". CouAt Mahtomedi, MN 55115 "— <br /> EMERGENCY/FIRE NUMBER ROAD NAME County Rood A <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) Lot_ 3, CSM Vot. 11 , Pa. 242, Sectiion 3, T39N, RIM), U1 <br /> Town o . eenon <br /> CONTRACTOR <br /> TYPE OF PERMIT(S). DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY X PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> { m <br /> STRUCTURE/ADDITION USE: SO_r9.Ctaluh :i , LU 0I/)'jam I i;� 111 <br /> (Home/Cabin;Commercial Bu)iness; Bedroom;D ck;etc.) Z m <br /> o ° <br /> v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) N <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). X41' <br /> 2. Show the location of the well (W),septic tank (ST), and drainfieid (DF). o <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 /> a 6- <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 21 <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I o m <br /> PLOT PLAN 0 Q <br /> o n <br /> M a <br /> AA <br /> n_ <br /> O <br /> 0 <br /> SCE .ATTACHED °_ w <br /> g <br /> N <br /> n <br /> Z <br /> c w r>D 0 <br /> a :Em <br /> m m <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F �12 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N: M <br /> m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. "' ;: O o m <br /> ff <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 informs- «�m>: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- 8 igo <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $'S 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 d, <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m ; 3 'oo <br /> 0 A N <br /> SIGN HERE <br /> Wade RuAzhotm 10/13/93 ° <br /> u i $ <br /> (signature of owner or building contractor) (date) '. 8 <br /> ZONING ADMINISTRATOR Z"�n <br /> HHMM M <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N m <br /> 0o0 ) <br />