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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d ' o o <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <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 3 a <br /> regulations of the State of Wisconsin. H ° <br /> w ,^p <br /> Nick 9 Becku Kuehn a ° <br /> OWNER (Please Print) Contractor or Surveyor or Agent m <br /> 25122 Lakeview Road <br /> m <br /> Address Address <br /> Schen, W1 54872 <br /> City, State,Zip Code _ City, Stale, Zip Code <br /> Telephone Telephone <br /> Emerency/Fire No. and Road Name <br /> Lo? 10, BCock 5, Mound Beach, Section 34, T39N, R16W, Town ob Meenon <br /> Legal Description (as Indicated on tax statement) o <br /> c� <br /> Permit(s) Applied for: 0 ° <br /> w r <br /> Dwelling Addition Filling/Grading Camping Unit °— <br /> v <br /> Z o <br /> Accessory Building Sanitary X Privy Subdivision ° <br /> Garage I6�) r <br /> $anitoA OKu O <br /> Structure Use: yn0 <br /> 0 <br /> (family home/cabin,garage, addition,etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) X <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). O o <br /> 2. Show the location of the well (W),septic tank (ST),and drainfieid (DF). 3 w <br /> 3. Show dimensions In feet of the following:(a) building toall lot lines,(b)building tocenter line ofroad,(c)building � Z ii' <br /> measurement to the ordinary high water mark of lake,stream,or river. o a <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. t <br /> C <br /> PLOT PLAN <br /> M <br /> t <br /> 0 <br /> w <br /> 0 <br /> N �J <br /> SEE ATTACHED o <br /> z <br /> l � <br /> o c m m n g m <br /> m 9 '° a <br /> deo 3 ,o 3 <br /> Z ioo o ,z : 1 <br /> y <br /> = m m <br /> � i ct � O <br /> C <br /> S mA : M <br /> I 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- w m w O <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 g 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- N <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. w 8 A <br /> A H <br /> SIGN HERE Wade Ru hhoXxn <br /> (signature of er u' ontractor) \ I r (d e) ` <br /> ZONING ADMINISTRATOR <br /> TO NSHIP PERMITS MAY BE REQUIREAUG 61992 rN o o S m <br /> � 888 8888 <br />