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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator1O l o <br /> APPLICATION FOR — LAND USE — PERMITS3, <br /> m ° <br /> TO THE ZONING ADMIta4STRATOR: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 m m <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and _ n <br /> regulations of the State of Wisconsin. y m <br /> w <br /> OWNER (>✓inzton 9 Peggy RodackeA TELEPHONE n �E <br /> m_ 1D <br /> ADDRESS 850 KnowteA Ave. N. NeWRichmond, (VI 54017 m <br /> EMERGENCY/FIRE NUMBER 7753 ROAD NAME Round Lake Road � <br /> LEGAL DESCRIPTION (see tax receipt) pct. G.L. 5, Sec. 33 T41N R16(V Town oA SWiAA <br /> CONTRACTOR (�l <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION /T 0 <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 o� <br /> r <br /> STRUCTURE/ADDITION USE: San2tctAy On2N o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> Di <br /> o ° <br /> a <br /> m <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). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions infeet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building .0 <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 9 <br /> dated by the owner. O <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTfE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a w <br /> c <br /> PLOT PLAN o 'n <br /> fn o <br /> C ) <br /> N <br /> m <br /> SEE ATTACHED <br /> N <br /> m <br /> n_ <br /> 0 <br /> 0 111 <br /> O � <br /> w <br /> Z <br /> Z <br /> I <br /> 0 o c o o. m <br /> m anN a `= M <br /> CONDITIONS OF PERMIT: A 5. ,z m o o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F T T'Z : a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (� _ N m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. v' �" : m o C <br /> $ c : <br /> a , <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- w m Fn O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infori ro <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I m $ <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. I agree to permit county officials charged with administering county ordinances or other authorized person to have N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. g �, <br /> m : A w <br /> SIGN HERE <br /> (Dade Ru AhoPm 8/12/92 <br /> n : <br /> (signature of owner or building contractor) (date <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MACE REQUIRED <br /> I ut ut In oa . m <br /> AUG 131 �ss ssssN <br />