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a� cow <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d 'o o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3_ <br /> iS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � H <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 Courtly Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. ou— <br /> m m <br /> N <br /> C <br /> m <br /> OWNER Dave Ke-fby TELEPHONE )672) 920-9542 <br /> m <br /> ADDRESS 5509 M-LAAOh Lahe.a DA2ve Edina, MN <br /> EMERGENCY/FIRE NUMBER ROAD NAME BeAf✓tam Road �✓ <br /> LEGAL DESCRIPTION (see tax receipt) r ` 2 <br /> V <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> m <br /> SANITARY X PRIVY FILLING/GRADING <br /> CAMPING UNIT SUBDIVISION o ° <br /> STRUCTURE/ADDITION USE: San4taAy On&[ !(/e'U.� j2h'1ii �f�cX�(IP� o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z v <br /> o <br /> 0 <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 9 <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 dreinfield (DF). <br /> 3. Show dimensions in feet ofthefollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordinary high water mark of lake, stream, or river. 0 �' <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. O o° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a N <br /> c <br /> PLOT PLAN o a <br /> � I <br /> G c <br /> 0 <br /> N <br /> J <br /> J <br /> x] <br /> SEE ATTACHED <br /> 3 1J <br /> Z <br /> a <br /> f <br /> n J n c m m <br /> m <br /> CONDITIONS OF PERMIT: 0 <br /> $ m Q T 8 <br /> 1, DRIVEWAY MUST MELT DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F o r� ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - yn <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o g C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- = (n y a M <br /> tion contained in this application(including an accompanyingschedule and I further declare that 1 recognize that this infor- J. v �" B g - <br /> P (� 9 Y 1 9 O <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o° b <br /> 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.I agree to permit county officials charged with administering county ordinances or other authorized person to have ? O m o <br /> access to the above described premises at any reasonable time for the Purpose of inspection. m o m <br /> R- <br /> M [ a A A 0 <br /> m <br /> SIGN MERE (°Jade RL:�dFIOgJn 7 1 <br /> (signature of owner or building contractor) E <br /> ZONING ADMINISTRATOR ( I eEEt g <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N N m <br /> Im <br /> � � - o0o to <br />