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Burnett ,County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ,N, 'a 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> 0 o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and �_ n <br /> regulations of the State of Wisconsin. H m <br /> N A <br /> Jenny and Susan En" a 0 <br /> OWNER (Please Print) Contractor or Surveyor or Agent o � <br /> 1804 County View Road <br /> Address Address <br /> Bm nsviUe, MN 55337 / � <br /> City,State,Zip Code City, State,Zip Code v \ 1 <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name (' <br /> pe,lF.Gov. Lo# 1 , Sectian 3 T39N Rlbw, Town nb Movann <br /> Legal Description (as Indicated on tax statement) <br /> Permit(s)Applied for: o ° <br /> m � <br /> Dwelling Addition Filling/Grading Camping Unit o °— <br /> v <br /> Z o <br /> Accessory Building Sanitary X Privy Subdivision ° <br /> Garage y� `1 /1,J <br /> Structure Use: Sanitaw Ung! — ldU+ I /iUE 17) r1-)- / TZ7Cj'1c � o <br /> (family h me/cabin, garage, addition, etc.) on <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) A <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). 0 <br /> 2. Show the location of the well (W),septic tank (ST), and drainf laid (DF). 3 <br /> 3. Show dimensions infest of the following:(a) building to all lot lines,(b)building to center line W road,(c)building 1111 Z c <br /> measurement to the ordinary high water mark of lake,stream,or river. o n <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m y <br /> dated by the owner. <br /> C , <br /> PLOT PLAN m U.) , <br /> I <br /> O <br /> i <br /> m <br /> n <br /> C <br /> U1 ° <br /> SEE ATTACHED <br /> o � <br /> w <br /> j� Z <br /> I <br /> A o c M. n m a m <br /> < � '2 Ce 0,0. A 3 <br /> ON . <br /> O ry <br /> sem : = N rn <br /> m <br /> C <br /> m c i 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 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- « m« O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 4 .`b' m N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 m g <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 u, <br /> access to the above described premises at any reasonable time for the purpose of inspection. w 8 m <br /> 3 ^ ` <br /> W RSH : <br /> Glade Ru sFa2m 51819.2_ <br /> SIGN HERE d' a <br /> (signature of owner or in t rAkctAbor <br /> ZONING ADMINISTRATOR 8 <br /> TOWNS P PERMITS MAY BE REQUIRED MAY 1 1 1992 <br /> 88888888UM) <br />