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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 9) M -- o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � y <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m `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. <br /> z <br /> c d <br /> n d O <br /> OWNER (Please Print) Contractor or Surveyor or Agent o <br /> Paul Tweet Donald Daniels a <br /> Address Address <br /> 790 Blair PO Box 316 <br /> City,State,Zip Code City, State, Zip Code <br /> Ct Pahl MN 5510, 54272 <br /> Telephone Te ep one f <br /> 612 227 9241 449SS.11 h <br /> Emergency/Fire No. and Road Name XXXXXX 21448 County "M" <br /> Legal Description (as indicated on tax statement) v <br /> n o0 <br /> Permit(s)Applied for: o <br /> m � <br /> Dwelling Addition Filling/Grading Camping Unit 8 °» <br /> Z <br /> T <br /> Accessory Building Sanitary H Privy Subdivision o a <br /> Garage <br /> Structure Use: <br /> (family home/cabin, garage, addition, etc.) j <br /> 0 <br /> 1A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: 0p <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 drainfieid (DF). 3 <br /> 3. Show the location of any lake or flowage- if within 1000 ft, and the location of any river or stream-if within P N <br /> 300 ft. z `c <br /> O a <br /> 4. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building s' <br /> to lake, river or stream, if applicable. 7K ? z <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C <br /> dated by the owner. (A <br /> in <br /> PLOT PLAN <br /> E <br /> cd <br /> N a <br /> See state approved plan ( c <br /> o <br /> o <br /> m <br /> N <br /> W <br /> (� V <br /> Z <br /> D Nm <br /> 0 N _V t- D ➢ p 17 <br /> o c m � a <br /> N. D K'� a L a- a p <br /> m <br /> H : Q <br /> 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 ofall informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- � in <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 8 m 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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 8 0 <br /> r 3 A <br /> SIGN HERE " i3dio <br /> (signature of owner or b 'I g co ac r) I v I (date) <br /> ZONING ADMINISTRATOR " 8 i <br /> ii N N O NHHN <br /> TOWNSH PERMITS MAY BE REQUIRED J � I� N u, N v, o o O m�I <br /> $ 8888 $ $ 8 ,, <br />