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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator J; m t o\' o <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 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the a c t t, <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 a c <br /> regulations of the State of Wisconsin. y <br /> w m > <br /> Phillip Hoefs g £ <br /> OWNER (Please Prim) Contractor or Surveyor or Agent o <br /> P C) Rnx 797 01 <br /> m <br /> Address Address <br /> Webster, WI 54893 <br /> City, State,Zip Code City,State,Zip Code <br /> I <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name <br /> int 3. CRM Vol - 9. Po-50-51 C;-T.. 2. Sec. 13, T40N R17W. Town of Union Z <br /> Legal Description (as Indicated on tax statement) o <br /> n e7 <br /> Permits)Applied for: o ° I <br /> 0 <br /> N r <br /> Dwelling Addition Filling/Grading Camping Unit o ° <br /> M <br /> Z o <br /> Accessory Building Sanitary X Privy Subdivision ° $ <br /> Garage <br /> Structure Use: Sanitary Only p� 5 <br /> (family home/cabin,garage,addition, etc.) l <br /> � t <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) C <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). 3 <br /> 3. Show dimensions In feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building � Z <br /> measurement to the ordinary high water mark of lake,stream,or river. o S <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and w <br /> dated by the owner. M 0 <br /> C <br /> PLOT PLAN m P- <br /> m <br /> n <br /> SEE ATTACHED m <br /> o � <br /> N <br /> n I (` <br /> Z <br /> t <br /> � omm � nm <br /> N . <br /> P i -'v, a <br /> iE m <br /> C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- i g o a <br /> edge and belief It is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- py:� m p <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this infor- 25 9 i <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 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.1 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. T 3 8 <br /> ' A <br /> SIGN HERE Wade Rufsholm <br /> (signature of owner or building contractor) <br /> ZONING ADMINISTRATOR chi I 4 8 <br /> SEP 2 31991 <br /> TOWNSHIP PERMITS MAY BE REQUIRED � J o o m <br /> —_- 88 8 $ 8m <br />