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GUIS�'Or15,,� Zrnpj � W,�, <br /> Burnett County.741Q Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m c a <br /> APPLICATION FOR — LAND USE — PERMITS3. o <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and �2 H <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> m c <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. H <br /> c <br /> OWNER Bob Suxn,60n TELEPHONE (715( 349-5453 n <br /> ADDRESS 24757 Anchort Inn Road Webster., WI 54893 <br /> EMERGENCY/FIRE NUMBER 24757 ROAD NAME Anchor Inn Road <br /> LEGAL DESCRIPTION (seetaxreceipt) pct. G.L. 1 , V.297, Pg. 486, Section 5, T38N, R15W, J <br /> CONTRACTOR Town o6 LaFoUette <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n 0 <br /> SANITARY x PRIVY ° <br /> FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: SanctaAy Onty o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) I m <br /> 0 0 <br /> 0 <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). (Fl <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). <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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 2 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on a rn <br /> c <br /> PLOT PLAN o a <br /> m 0 <br /> 0 <br /> w <br /> m _J <br /> 0 <br /> l <br /> I N <br /> m <br /> SEE ATTACHED <br /> N <br /> o G,1 <br /> b <br /> l7 y <br /> " <br /> w <br /> U1 <br /> Dg� am a � <br /> CONDITIONS OF PERMIT a y.: z C8 = r. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = =y00 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N' 32 m <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. o m C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs. <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g`$ <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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> a v A 0 <br /> m m <br /> SIGN MERE Wade Rujzholm <br /> 16 93 <br /> (signature of owner or building contractor) f2 Pi61ef7 r nil o <br /> ZONING ADMINISTRATOR I - ' <br /> g i E <br /> TOWNSHIP PERMITS MAY BE REOUIRD' 7 o N N N N m <br /> rn <br /> 000 0000 <br />