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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratoro 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> d 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 3 n <br /> regulations of the State of Wisconsin. y m <br /> w m <br /> JeAAu Nonwood a f <br /> OWNER (Please Print) Contractor or Surveyor or Agent o <br /> 11980 State Rd 48 <br /> Address Address / 1 <br /> Gnant,s6Wcg, wI 54840 <br /> City,State,Zip Code City, State,Zip Code <br /> (715) 488-2417 <br /> Telephone Telephone <br /> Emergenc <br /> IF No. and Road Name h <br /> Pc2. S i/4 SE 1/4 Section 16, T37N, R18w, Town o4 Thade Lake <br /> Legal Description (as Indicated on tax statement) o <br /> n � <br /> Permit(s) Applied for: o °. <br /> m � <br /> Dwelling Addition Filling/Grading Camping Unit °- <br /> v <br /> z o <br /> Accessory Building Sanitary X Privy Subdivision m <br /> Garage <br /> Structure Use: San�taAy Only. <br /> (family home/cabin, garage,addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 1o1-II�_I <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 drainfield (DF). 311 � y <br /> 3. Show dimensions In feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building .0 Z Q <br /> measurement to the ordinary high water mark of lake,stream, or river. o o. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m H <br /> dated by the owner. 1 <br /> C <br /> PLOT PLAN m <br /> ) I� <br /> V1 <br /> 0 <br /> 0 <br /> SEE ATTACHED N <br /> 0 <br /> m <br /> R <br /> N_ <br /> n <br /> Z <br /> J � <br /> J <br /> A o c m m o a F MM <br /> m <br /> .2 o 0 ,'o 3 <br /> Z A o m .2 : -I <br /> ! y i i M <br /> — m <br /> N i G O <br /> g <br /> n � 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 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- <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. 1 g 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 ,„ <br /> access to the above described premises at any reasonable time for the purpose of inspection. m g 0 <br /> m A H <br /> Wade Ru44hotrn 5/19/92 w € <br /> SIGN HERE d' a <br /> (signatur of owner or buildingcontractor) (date) o i <br /> ZONING ADMINISTRATOR ��,Ih <br /> TOWNSHIP PERMITS MAY BE REOUIREDo ,o fS m <br /> 88 $ m <br />