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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. o <br /> w m <br /> m <br /> C <br /> OWNER Doug EdwaAde TELEPHONE 656-3266 0. f <br /> o <br /> m <br /> ADDRESS28798 Westyet.ow R-cven Road Danbcuey, WI 54830 a <br /> EMERGENCY/FIRE NUMBER 28798 ROAD NAME we.at yettow R-iveA Road <br /> C::7 <br /> LEGAL DESCRIPTION (see taxreceipt)Lot 10 Pine Ridge Subdivision, Sec 18 T40N R16W Qxl <br /> CONTRACTOR Town ob Oakt.nd <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY x PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> o <br /> STRUCTURE/ADDITION USE: Sanita)ty On.b o o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> 0 0 <br /> 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). 0 <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 A <br /> dated by the owner. o a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on v N <br /> PLOT PLAN 11 Z <br /> o a <br /> m o <br /> C I <br /> a <br /> m W <br /> �p <br /> SEE ATTACHED <br /> s <br /> 0 <br /> o <br /> O y <br /> V1 <br /> Z <br /> S <br /> C <br /> D <br /> O C p o o prn <br /> m, a �� 'w0am m y <br /> CONDITIONS OF PERMIT: Z m <_" ; C N o K <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z o ``z <br /> O O T N D <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ .. m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. f"n : G0 C <br /> 8 R <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- www l7 <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 'meg m 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 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. m <br /> P <br /> 3A <br /> o e <br /> SIGN HERE <br /> (wade Ru{thhotm 10602 w N <br /> (signature of owner or buijdlng c Ira toq, <br /> ZONING ADMINISTRATOR �L <br /> TOWNSHIP PERMITS MAY BE REQUIRED "N o o w$ m <br /> OCT - 61 888 ' 8888x, <br />