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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator mo 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> 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 n <br /> regulations of the State of Wisconsin. H m_ <br /> John R. SwedbeAg, JA. n o <br /> f <br /> OWNER (Please Print) Contractor or Surveyor or Agent o <br /> 2653& Lake&nd Ave. N. m <br /> Address Address <br /> webztm w1 54893 C1 <br /> City, State,Zip Code City,State,Zip Code S <br /> (715) 866-4646 <br /> Telephone Telephone <br /> #6713 County Rd. X <br /> Emergency/Fire No. and Road Name <br /> SE i/4 NE 1/4 Sec. 15, T39N, R16w, Town o{t Meenon <br /> Legal Description (as Indicated on tax statement) <br /> G) <br /> Permit(s)Applied for: 0 °- <br /> DwellingAddition Filling/Grading Camping Unit <br /> v <br /> 0 <br /> Accessory Building Sanitary Privy Subdivision ° <br /> Garage � a <br /> Structure Use: Sa;tdtyttj, 0ny — �� (i u�6 I �M i,7— J)t'o( <br /> 0 <br /> (family ho /cabin, garage,addition, etc.) <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). a <br /> 2. Show the location of the well (W),septic tank (ST), and dralnfield (DF). 3 <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building 4Z o <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 <br /> dated by the owner. C i <br /> PLOT PLAN m W <br /> Q <br /> 1 <br /> a <br /> n_ <br /> 0 <br /> 0 <br /> SEE ATTACHED y�vIJ1` <br /> n I— <br /> Z <br /> S1 <br /> o c m m o n m <br /> w o 5 m <br /> z0 <br /> ZQ : -i <br /> F 0 21 N i : M <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knows- rr,K� N : m <br /> V'— : <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 O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- m u [ <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 80 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. 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. 0 <br /> 80. <br /> m 3 0 : <br /> A w <br /> Wade Ru�zhoX.m <br /> SIGN HERE H a <br /> . r• i <br /> (signature of owner or building contractor) <br /> ZONING ADMINISTRATOR g <br /> TOWNSHIP PERMITS MAY BE RE UIRED if I MAY i 8 19 92 o o 8 m <br /> ��_ <br /> 888to <br />