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Burnett C Its 7410 Co. Rd. K, No. 102, Siren, WI 54972 Office of Zoning Administrator ( m E o <br /> APPLICATION FOR — LAND USE — PERMITSm X ° -- <br /> a <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 2 w <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 Cade,and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. , m <br /> G m <br /> J. E. HenAich a f <br /> OWNER (Please Print) Contractor or Surveyor or Agent o <br /> 116 Campbettn S.tne-t <br /> Address Address <br /> PAucott, w1 54021 <br /> City,State,Zip Code City,State,Zip Code ) <br /> (715) 262-3317 R� <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name <br /> eK. StU 114 SE 114 Sec. 20 T40N R15E Town oA Jack.6on <br /> Legal Description (as Indicated on tax statement) g <br /> Permits)Applied for: o' <br /> n <br /> w r- <br /> Dwelling Addition Filling/Grading Camping Unit c ° <br /> •o <br /> Z o <br /> AcceBuildingSanitary X Privy Subdivision <br /> S ° $ <br /> r <br /> Structure Use: Sant-tart Onlyc <br /> (family home/cabin,garage,addition,etc.) <br /> 1A <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 dralnfield (DF). 0 3 <br /> 3. Show dimensions Infest of the following:(a)bullding to all lot lines,(b)building to center line of road,( )building Z c <br /> measurement to the ordinary high water mark of lake,stream,or river. o <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and H I� <br /> dated by the owner. fillC <br /> PLOT PLAN <br /> I�t� <br /> d o <br /> SEE ATTACHED. <br /> v � <br /> N <br /> lit <br /> Z <br /> I � <br /> I� <br /> G <br /> ocz-zm n m <br /> Zi= Zi Z $20? a <br /> N . <br /> O O Z2 <br /> Its <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best or my knowl- c ? ° _"-: ; In <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 yy!�o f±: O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 75 o i7 <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 8 0 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.1 agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> ection. <br /> access to the above described premises at any reasonable time for the purpose of Inspm 8 <br /> B O ^ « i <br /> SIGN HERE wade RUbdhotrff 411819 <br /> (signature of owner or building contr c or) (date) c , <br /> ZONING ADMINISTRATOR . E .` g ' '. <br /> N. <br /> TOWNSHIP PERMITS MAY BE REQUIRED to 9 A <br /> $ 88888$ 8ro <br />