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Biunett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U) 'a0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the o m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. �, d <br /> N 0^ <br /> Eugene F. Badzinski a -o <br /> OWNER (Please Print) Contractor or Surveyor or Agento 'm <br /> 2736 Hamlet Avenue North R <br /> Address Address <br /> Oakdale, MN 55128 <br /> City, State,Zip Code City, State,Zip Code <br /> (612) 779-9581 <br /> Telephone Telephone <br /> I <br /> Emergency/Fire No. and Road Name <br /> Parcel in Government Lot 3, Section 20, T40N, R14W. Tann of Scott <br /> Legal Description (as Indicated on tax statement) <br /> n <br /> Permit(s) Applied for: 0 � <br /> a r <br /> Dwelling Addition Filling/Grading Camping Unit ° I <br /> v 1 � <br /> Z o <br /> Accessory Building Sanitary X Privy Subdivision P <br /> Garage } 0 <br /> Structure Use: Sani tarn Only _ r <br /> (family home/cabin, garage, addition, etc.) <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). o <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). c m <br /> 3. Show dimensions infeetofthefollowing:(a)building to all lot lines,(b)buildingto center line of road,(c)building 11 <br /> 1 Z `o <br /> measurement to the ordinary high water mark of lake,stream, or river. o a <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and O H. <br /> dated by the owner. M <br /> C � <br /> PLOT PLAN m 5 <br /> J <br /> i <br /> I N <br /> 0 <br /> SEE ATTACHED. 0_ _ lO <br /> m <br /> v .� <br /> y <br /> J <br /> 7 <br /> i <br /> f <br /> o c m m Q. rmrt <br /> > > n a <br /> 2 o mZ 1 <br /> o E N m <br /> G) � O <br /> ` ' ' M <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o 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- 00 w O <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 a 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 n "' o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 8 m <br /> 3 A ° <br /> Wade <br /> 10/2/91 ' <br /> ae RufsholmPo a <br /> SIGN MERE <br /> (signature of owner or building contracto Id 1 <br /> o ? <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS M BE REOUIRED <br /> $ 8888y <br />