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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratorm o a <br /> APPLICATION FOR — LAND USE — PERMITS 3. J <br /> m a <br /> TO THE ZONING ADMINISTRAT R:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The unc ersigned agrees that all work shall be done in accordance with the requirements of the IR m J <br /> Burnett County Land Use Ordinan e, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. m <br /> c <br /> OWNER Jenny MozeA. TELEPHONE (612) 462-2829 n <br /> o m <br /> m <br /> m <br /> ADDRESS 26712 Fneepont We. Wyming, MN 55092 <br /> EMERGENCY/FIRE NUMBER 2 741 ROAD NAME MOAeA Road r <br /> LEGAL DESCRIPTION (seetaxrecei t) Lot { CSM Vot. 8 Pg 3 Section 29 T40N R15W, 1 6) <br /> CONTRACTOR Town ob Jackson t ' <br /> TYPE OF PERMIT(S): DWELLING/B ILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> 1 O <br /> SANITARY XPRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> �^ r <br /> STRUCTUREIADDITION USE: SanitoA' DnTv ° g <br /> m <br /> ( ome/Cabin;Commercial Business; Bedroom;Deck;etc.) a o <br /> DIRECTIONS FOR PLOT PLANDRAWING: (Aerial or top view) `F-� } Cj- <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 we I (W), septic tank (ST), and drainfield (DF). ° �j <br /> 3. Show dimensions infeet of ft a following:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinarl high water mark of lake,stream, or river. Q <br /> 4. If separate plans are submitt d by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o <br /> 9 2 0 <br /> PLOT PLAN 0 a <br /> m <br /> N <br /> mI 3 <br /> t <br /> N <br /> A <br /> SEE ATTACHED o <br /> O I/ <br /> o <br /> z <br /> n <br /> IVB <br /> CONDITIONS OF PERMIT, o y, z CS ON t° <br /> 1. DRIVEWAY MUST MEET D IVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 : <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N - M <br /> m <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. n b : <br /> I declare that this application(ir cluding any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,coned and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- H m m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- O <br /> mation I am providing will be lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o� ` <br /> r <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 cour ty officials charged with administering county ordinances or other authorized person to have iO N p <br /> access to the above described remises at any reasonable time for the purpose of inspection. 3 0 9- <br /> m N . <br /> Wade Ru zhotm <br /> 6/26/94 <br /> SIGN HERE "' <br /> (signature of owns or building contractor) (date) <br /> g <br /> ZONING ADMINISTRATOR X <br /> TOWNSHIP PERMITS MAY BE REOUIRED �o W. <br /> X <br /> 000 <br /> X X X N <br /> EA X N <br /> F' <br /> N <br /> O <br />