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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratora o <br /> APPLICATION FOR — LAND USE — PERMITS3. ' <br /> m 0 <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 m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. m m <br /> N A <br /> 70AAA0 Qm,ith £O <br /> OWNER (Please Print) Contractor or Surveyor or Agent o <br /> 7667 County Road FF <br /> Address Address <br /> Web�5teh , WI 54893 <br /> City, State,Zip Code City,State,Zip Code <br /> ( 775 ) 866-7155 n <br /> Telephone Telephone V <br /> 7667 County Road FF <br /> Emergency/Fire No. and Road Name <br /> PC <br /> t. NE 1 /4 SW 1 /4 Sec . 8 , T39N, R16W, Town oA Meenon. Bunnett <br /> Legal Description (as indicated on tax statement) County - <br /> Permit(s) <br /> ount_y .Permit(s) Applied for: o °. <br /> o - <br /> �' r <br /> Dwelling Addition Filling/Grading Camping Unit <br /> v <br /> Z o _ <br /> Accessory Building Sanitary —X— Privy Subdivision P_ <br /> Garage <br /> Structure Use: Sanitcycu Unto. t <br /> (family home/cabin, garage,addition, etc.) <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) M <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 (yi),septic tank (ST), and drainfleld (DF). 3 <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building Z c <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 m o�O y <br /> dated by the owner. C 1 ; I I ' <br /> U1 <br /> PLOT PLAN m G <br /> Z <br /> o <br /> 0 <br /> SEE ATTACHED N <br /> 0 <br /> 0 <br /> O y <br /> Its\V\ <br /> N I� <br /> f <br /> � o � � mm � agm <br /> `= n <br /> < m o 0 Z3 <br /> 9 £ 0 T`� M <br /> -.m: m <br /> - m <br /> l N G) O <br /> 8i a C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 4 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 informa- <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 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 Out o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 80 ; <br /> n V A w r <br /> SIGN HERE Wade Rufohotm <br /> (signature of owner or building contractor) (date) c <br /> ZONING ADMINISTRATOR 5--r nl) . . . <br /> TOWNSHIP PERMITS MAY BE REOUIRED G rm o o� m <br /> $8 $ 8888UM) <br />