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Opt-C , <br /> Burnett Courtly 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Admini Btrator Nm o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> d <br /> TO THE,ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a [ <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme s of the <br /> Burnett Courtly Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the I ws and _ v <br /> regulations of the State of Wisconsin. <br /> u m ^ <br /> OWNER TELEPHONE $ ( 1 O <br /> James 6 Elizabeth Beer (612) 922-0164 m � <br /> ADDRESS ( � <br /> 5804 Jeff Place Edina, MN 55436 ((�1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME Sieben Road <br /> I s <br /> LEGAL DESCRIPTION (seetaxreceipt) Lot #1, CSM Vol. 8, Pg. 260-261, G.L. 11, Sectior 7, <br /> 140N, KIJW, Town of jaciEson <br /> CONTRACTOR .. <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION l g <br /> n L1 <br /> SANITARY % PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION` 0 0 <br /> N <br /> STRUCTURE/ADDITION USE: <br /> Sanitary �{" �I� ! � OJ l �' ;L 6 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) z e <br /> .0 o J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> l� <br /> 1. Show the location and size of all existing buildings (ES) and all new buildings (NB) and Indicate No (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions In feet ofthe following:(a)building to all lot lines,(b)building to center line of road,(c) building Ill) <br /> measurement to the ordinary high water mark of lake,stream,or river. O f <br /> 4. if separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. O o m <br /> 1A Z a <br /> PLOT PLAN c o <br /> O <: <br /> N <br /> O <br /> C <br /> In <br /> SEE ATTACK. G° <br /> -- o <br /> m <br /> o <br /> z <br /> �' IV <br /> j m <br /> g --n <br /> 4 a <br /> CONDITIONS OF PERMIT: Z �': Z g ffi g IC <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` IRE `• Qi <br /> ' m0 <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best o my knowl. <br /> C <br /> oZ <br /> edge and belief It is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of 1 informs- N b ' m <br /> lion contained In this application(including any accompanying schedule)and I further declare that I recognize th this Infor- �' t i� p <br /> motion I am providing will be rolled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. 1 $ $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providin in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pe n to have <br /> access to the above described promises at any reasonable time for the purpose of Inspection. mT !o¢ <br /> m is ii <br /> Wade Rufsholm 3/27/9 <br /> SIGN HERE '• « ' <br /> (signature of ow or Ildl nt ton r, (date) <br /> i <br /> ZONING ADMINISTRATOR (� - ` 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED C'11- <br /> % <br /> $ 8�$$i8'$ w <br />