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&�) "0' <br /> Burnett C6unty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. — <br /> d <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and °located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the M c <br /> 3 C <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. H m° <br /> N m <br /> Tom Pa rnen n a <br /> f <br /> OWNER(Please Print Contractor or Surveyor or Agent v <br /> 4219 NaAth Remon-t Avenue <br /> Address Address <br /> McnneapaK2,s, MN 55412 <br /> City,State,Zip Code City, State,Zip Code <br /> l <br /> Telephone Telephone <br /> Emergency/Fire N . and Road Name <br /> pere2 NE i/4 SE 7/4 Section 3, T37N, R18W, Town o4 TAade Lake <br /> Legal Description (as Indicated on tax statement) <br /> n G1 <br /> Permits) Applied for: o ° <br /> m r <br /> Dwelling Addition Filling/Grading Camping Unit °— <br /> v <br /> = o <br /> Accessory Building Sanitary X Privy Subdivision ° <br /> Garage <br /> Structure Use: SanitaAg Un2u <br /> (family home/cabin, garage,addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 31 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). o <br /> 2. Show the location of the well (W), septic tank (ST), and drainfleld (DF). 0 o 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 z `o <br /> measurement to the ordinary high water mark of lake,stream,or river. o o <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m m' <br /> dated by the owner. C ° <br /> PLOT PLAN <br /> �A1 V 1 <br /> Q 0 <br /> o` <br /> SEE ATTACHED. ° <br /> o � <br /> m 11 <br /> ° <br /> Z <br /> z <br /> I <br /> m=a 00 a �= a <br /> c < 3 j Q3 o <br /> a <br /> m <br /> ms `s : o <br /> C <br /> 8 : s <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best f my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- -' «m« 0 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation 1 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- N <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have n u o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 89 <br /> m <br /> Wade Ru6hho2m 6 21/92 8 <br /> SIGN MERE ; <br /> H� n <br /> (signature of owner or building contractor) (date) c x <br /> ZONING ADMINISTRATOR <br /> 1 ««« T <br /> TOWNSHIP PERMITS MAY E REQUIRED N o o m <br /> 8 8 888 N <br />