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otoLc+�l P, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o c <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and v m o <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m c <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 a d <br /> tions of the State of Wisconsin. o <br /> N N <br /> ROBERT J. KRANZ PEOPLE'S CONCRETE & MASONRY CONSTR = () <br /> OWNER(Please Print) Contractor or Surveyor or Agent 0 F <br /> 2321 E STANDRIDGE AVE 30130 COUNTY ROAD H <br /> Address Address <br /> MAPLEWOOD, MN 55109 WEBB LAKE, WI 54830 <br /> City,State,Zip Code City,State,Zip Code <br /> 612-7777938 715-259-3355 <br /> (T- <br /> Telephone Telephone M <br /> 29443 COUNTY ROAD H (FISH LAKE) <br /> Emergency/Fire No. and Road Name <br /> GOVT LOT 4, SECTION 4, TWNSHIP 40N, R14W PCL #40.14.04.01800 <br /> Legal Description(as indicated on tax statement) o <br /> Permit(s)Applied for: 0 <br /> 0 <br /> New Building Sanitary Filling/Grading Camping Unit m <br /> Addition XXX Privy Moving Subdivision o (W <br /> Structure Use: ADD BASEMENT UNDER PORTION OF EXISTING CABIN o <br /> 0 <br /> (family home/cabin, garage, type of addition, etc.) <br /> Directions for plot plan drawing: <br /> 1.Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North (N). <br /> 2. Show the location of the well(W), septic tank(ST), and drainfield(DF). <br /> 3.Show the location of any lake or flowage- if within 1000 ft. and the location of any river or stream - if within 300 ft. R) <br /> 4.Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building to ordi- <br /> nary high water mark of lake, river or stream, if applicable. <br /> 5. If,separate plans are submitted by an architect,engineer, builder,contractor,etc.,the plans must be signed and dated by <br /> the owner. n Q <br /> 0 <br /> 3 (e <br /> PLOT PLAN v <br /> / .0 C <br /> 0 ^ <br /> cc <br /> O_ <br /> t `) <br /> \1 a <br /> CD <br /> O p O <br /> 31 <br /> t 3o i <br /> f <br /> 301 N <br /> -C <br /> c <br /> Z <br /> i <br /> �m am<v.mfnmr 0DaDcQJm- 9 <br /> y� / g m a� - am =am <br /> 3p �JQt be- C-01- r-l- l �3 z o i P ':2 S of 3 <br /> aa P 0 m i A <br /> d�abeWten{ unpsY C�i�tS�trc � t— -U Na: m <br /> `n i o [ A <br /> o: o C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- <l m <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 : a <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. <br /> m <br /> SIGN HERE 3/6/90 <br /> (s' a e of own r o b 'ding c tractor) E o <br /> ZONING ADMINISTRATOR [3 gum EO <br /> T <br /> NNON� Nm <br /> TOWNSHIP PERM S MAY BE REQUIR _ 8 m <br /> 888$8 8m <br />