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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 'ryNI z <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZdNING`ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c <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 n <br /> regulations of the State of Wisconsin, w o <br /> w � <br /> c <br /> OWNER Robert YiraTELEPHONE n O <br /> 715-483-9404 m <br /> ADDRESS Rt 3 St Croix Falls WI 54024 m <br /> EMERGENCY/FIRE NUMBER ROAD NAME Little Wood Lake Rd ( o <br /> Q <br /> LEGAL DESCRIPTION (seetazreceipt) NWY<NE'/. S2 T37N R18W Trade Lake Twnshp h <br /> CONTRACTOR Donald Daniels <br /> Z <br /> d <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n O <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVIS ONo <br /> o <. <br /> STRUCTURE/ADDITION USE: T CY) T o ° <br /> (Home/Cabin;Com ercial Business;Bedro m;Deck;etc.) <br /> Z 'o <br /> o v <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). 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 5 <br /> measurement to the ordinary high water mark of lake,stream,or river. VVII�"tTT") 01 <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. C b' Vo <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an o rn <br /> c <br /> PLOT PLAN 41 o oh n <br /> o g <br /> C I c+ <br /> c+ <br /> m <br /> 0 <br /> O <br /> I o <br /> a z <br /> M <br /> 1 a <br /> x <br /> See attached <br /> n <br /> 0 <br /> J <br /> m <br /> N <br /> O Z N <br /> J (D <br /> b N) <br /> O N � <br /> m N <br /> W <br /> r^ W V <br /> z <br /> y <br /> 00 <br /> fnN Vln t- DD m <br /> ELF > ? � am <br /> CONDITIONS OF PERMIT: o < °i c H o � 9 <br /> S. N `z N o J 10 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a F T1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ 0 � m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED, m c C <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 informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 <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 . p <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 8 9 <br /> T A <br /> SIGN HERE Ge� �^-' -7110492 <br /> (signature of owner o 'd' con tor) ate) ' <br /> E x I <br /> ZONING ADMINISTRATOR Z:_ �v <br /> TOWN PERMITS MAY BE REOUIRED JUL 2 7 1992 g!N c o m <br /> 88 8888m <br />