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- <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratorm m o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> s <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 3 $ <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 /> m <br /> John Volaren $ <br /> F <br /> OWNER(Please Print) Contractor or Surveyor or Agent m° <br /> Box 188 m <br /> Address Address <br /> Balsam Lake, WI 54810 <br /> City,State,Zip Code City,State,Zip Code <br /> (715) 485-3194 i <br /> Telephone Telephone <br /> i <br /> Emergency/Fire No. and Road Name <br /> I;cl Gov Tot- 1 . Sar 13. T41 R1 Wast, Tnwn of Swiss <br /> Legal Description (as Indicated on tax statement) <br /> Permit(s)Applied for: 0 a- <br /> Dwelling .. Addition Filling/Grading Camping Unit a <br /> v <br /> z o <br /> Accessory Building Sanitary X Privy Subdivision ° } <br /> Garage <br /> Structure Use: San; Ary <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). <br /> 2. Show the location of the well (W),septic tank (ST),and drairdieid (DF). an a 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 <br /> measurement to the ordinary high water mark of lake,stream,or river. ° <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m <br /> dated by the owner. C ) ° <br /> 0 <br /> PLOT PLAN M <br /> X <br /> I ' <br /> i; <br /> m 0 <br /> SEE ATTACHED o <br /> N <br /> n I ^ <br /> Z <br /> I17 S <br /> D NN � tn r- DD � T <br /> �. 9a� aam $ n <br /> � cc03 3 <br /> o <br /> ' 41 = i m <br /> c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 0m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- y¢!!m�+ O <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- t5 « N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 m $ <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. y� <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have C)iX O <br /> access to the above described premises at any reasonable time for the purpose of inspection. $ 89 <br /> SIGN HERE Wade Rufsholm 9/8/91 <br /> (signature of owner o b din <br /> ZONING ADMINISTRATOR 8 <br /> TOWNS PERMITS MAY BE REQUIRED o o 'n <br /> 988 "v <br />