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OYL C.W1W <br /> Burnett Courity 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rn z <br /> w m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3 _TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and '2 rn <br /> located 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 a <br /> regulations of the State of Wisconsin. o <br /> w d <br /> w � <br /> c <br /> w O <br /> OWNER ChUCR and Diane Medagt2a TELEPHONE (612) 483-9012 a >; <br /> O � <br /> ADDRESS 9 High C2hcfe (�lau Nora h Oaks, MN 55121 m <br /> EMERGENCY/FIRE NUMBERROADNAME COUtn-ty Road A <br /> LEGAL DESCRIPTION (seetaxreceipt) paAt 06 G.L. 1 , SeC-t2on 3, T39N, R76W, Town o4 Meenon <br /> CONTRACTOR //�`1 <br /> kl" <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION I <br /> SANITARY x PRIVY FILLING/GRADING CAMPING UNITSUBDIVISION o o ('D <br /> ^' <br /> w W <br /> STRUCTURE/ADDITION USE: _ $O.n4-t0✓!rT OVbY.Ir o 0 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z v <br /> 0 0 _ <br /> D <br /> A <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). (Sl <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (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. 11 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. O O <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFrE VERIFICATION BEFORE A PERMfr CAN BE ISSUED. 0 9 <br /> W <br /> PLOT PLAN _� z Q <br /> n � s <br /> M y <br /> C <br /> m � - <br /> O <br /> C� <br /> 0 <br /> d <br /> 0 <br /> SEE ATTACHED <br /> 0 <br /> j llJ <br /> 7 <br /> 0 <br /> C7 � <br /> 2 <br /> CV <br /> (nr� G <br /> m O c-0 W r tDi a 0 -0 <br /> In <br /> CONDITIONS OF PERMIT: m M-� 2 0.0 e= � <br /> -5. � cb' . o0 � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 33 <br /> =y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 2 m <br /> 0 <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- - a y«. m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this Infor - v is g p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o� 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 t <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have N <br /> access to the above described premises at any reasonable time for the purpose of inspection. mom <br /> m 3 Q m <br /> m i m <br /> SIGN HERE <br /> 'Jade RIU(�. holm 5/31/93 <br /> (signatur f wne r building ontractort (date) " <br /> x[ <br /> ZONING ADMINISTRATOR <br /> s <br /> OWNSHIP PERMITS MAY BE REOUIRED o N N N m <br /> o ' o 0 0 o m <br /> 0 00 <br /> ow <br />