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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator (/)to m $ o <br /> APPLICATION FOR — LAND USE — PERMITS ' <br /> ,m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v e <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 _ <br /> regulations of the State of Wisconsin. m <br /> c m <br /> Betty LaBarre a f <br /> OWNER(Please Prim) Contractor or Surveyor or Agent m '� <br /> 130 Hwy. 96—Dellwood <br /> Address Address <br /> White Sear iakP- MN 55110 <br /> City,State,Zip Code City,State,Zip Code <br /> Telephone Telephone <br /> #29684 Long Lake Road <br /> Emergy/FireencNo. and Road Name <br /> Lot <br /> 2, <br /> CSM Vol. 7, Pg. 111-112, Sec. 34, T41N R16W, Swiss Township <br /> Legal Description (as Indicated on tax statement) <br /> i <br /> 9 0 0 <br /> Permit(s) Applied for: 0 ^- <br /> w � <br /> Dwelling Addition Filling/Grading Camping Unit ° o <br /> v <br /> Z o <br /> Accessory Building Sanitary X Privy Subdivision 0 } <br /> Garage �I I Pei�ffb ,.Structure Use: Sanitary Only l I O I l � 1 /71/l Ca-c o <br /> (family home/cabin,garage,addition,etc.) <br /> 1A <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 9 <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 draiMield (DF). 3 m <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building it Z <br /> measurement to the ordinary high water mark of lake,stream,or river. o o <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m <br /> dated by the owner. C 1 <br /> PLOT PLAN N <br /> m W <br /> I <br /> 0 <br /> I N <br /> O <br /> J <br /> SEE ATPAC IED o <br /> �. <br /> J <br /> o <br /> w <br /> r <br /> V I^ <br /> M 0c %0 - <br /> nnW rra <br /> W. a ii• Nam n <br /> q ZZ ? m i <br /> O J 21 (n <br /> c' a : m <br /> 8 m rn <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o 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- '� ` yy!� o ; O <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 25 'm N <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 E <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- S� <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have iy <br /> access to the above described premises at any reasonable time for the purpose of inspection. . ? aB $ <br /> SIGN HERE Wad if <br /> R shnlm 5/91 <br /> (signature of owner or building contr 0 eta) <br /> 5p V : <br /> ZONING ADMINISTRATOR f 8 a <br /> TOWNSHIP PERMIT MAY BE REQUIRED «o o~ m <br /> � m <br /> 89 99 0 <br />