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4r <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d ' ; o <br /> APPLICATION FOR — LAND USE — PERMITS3, <br /> v o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <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 <br /> regulations of the State of Wisconsin. w ,� <br /> Ken 6 <br /> DOAra GAant <br /> OWNER <br /> Contractor or or Surveyor or Agent uchanan St. NC a <br /> Address Address <br /> Minneapo. iz, MN 55418 .am. <br /> ' o> <br /> City,State,Zip Code City, State,Zip Code <br /> (715) 656-3137 <br /> Telephone Telephone <br /> R) <br /> Em Lot cylFlrSeNq.oadtd Boad9. N Section 35 T41N, RIM, Town ob Svizs <br /> CCMMV 9 Yg. <br /> Legal Description (as Indicated on tax statement) o <br /> � L7 <br /> 0 <br /> Permit(s) Applied for: o <br /> Dwelling Addition Filling/Grading Camping Unit o °- <br /> v <br /> 2 0 <br /> Accessory Building Sanitary X Privy Subdivision ° <br /> Garage <br /> Structure Use: Sang taay Onley <br /> (family home/cabin, garage,addition, etc.) � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). n <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). C 3 <br /> 3. Show dimensions infest of thefollowing:(a)buildingto all lot lines,(b)buildingto center line of road,(c)building Z c <br /> measurement to the ordinary high water mark of lake,stream,or river. o 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and y <br /> dated by the owner. fA 0 <br /> C I <br /> PLOT PLAN #A U-I <br /> I m <br /> n <br /> SEC ATTACHED <br /> n Ir— <br /> Z <br /> f <br /> W c m m o a m <br /> R K R am a <br /> a < ` � vC. o 0m 3 <br /> Z mo 0 ,2 : 1 <br /> o fo _ n y <br /> _ 2 m <br /> 8 ` m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- m <br /> o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- 'c H m a 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 i (u 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 a (1)- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have ut <br /> access to the above described premises at any reasonable time for the purpose of inspection. 8 R <br /> p A H <br /> SIGN HERE <br /> Wade Ru eho2m -___- - 7/24/92-- - <br /> (signature of owner or building contract I `, ` (date) <br /> jl. <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS M Y BE REQUIRED J� 2 8 I 0 �o 099 T <br /> 8 8888UM) <br /> U <br /> t� - <br />