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-- -. Qi 1 <br /> Bumett'County 7419 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d ' c c <br /> f <br /> APPLICATION FOR — LAND USE — PERMITS m 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 <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. <br /> w <br /> _ Ba1tb Reevroht n o <br /> OWNER(Please Print) Contractor or Surveyor or Agent c A <br /> 310 W. 12th St. m <br /> Address Address <br /> Hc�st.l * MN 55033 <br /> Ci16 State,Zip Code City,State,Zip Code <br /> .16121 437-9521 -� <br /> Telephone Telephone <br /> Emergent /Fire No. and Road Npme <br /> pct. NEy 1/4 NV 1/4 SEc/ 14, T40N R17W, Town ab Union <br /> Legal Description (as Indicated on tax statement) q <br /> Permit(s) Applied for: < rU <br /> w <br /> Dwelling Addition Filling/Grading Camping Unit o <br /> Z T <br /> Accessory Building Sanitary X Privy Subdivision ° <br /> Garage <br /> Structure Use: San2taAy Unty 6 <br /> (family home/cabin,garage, addition, etc.) <br /> Oill <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 (S-r),and dralnfield (DF). 3 <br /> 3. Show dimensions In feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building z o <br /> measurement to the ordinary high water mark of lake,stream,or river. o a <br /> 4. M separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. M5. <br /> I 1 <br /> C i <br /> PLOT PLAN m <br /> t <br /> i <br /> m <br /> SEE ATTACHED. <br /> o <br /> m <br /> R � <br /> w <br /> Z <br /> if <br /> I <br /> o c m a a m <br /> � anm s = 9 <br /> o 2 Z a om 3 <br /> Zoi eo : i <br /> P _ a <br /> T <br /> 8�E 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- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- »4yi E 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. 1 , 8 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- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of Inspection. 8 <br /> � n a <br /> SIGN HERE Wade Ru4AhoEm 416192 <br /> (signature of owner orbuild[ gcgn!mc <br /> ZONING ADMINISTRATOR r `E� `r' r g ' <br /> TOWNSHIP ERMITS MAY BE REQUIRED `0"'! m <br /> APR - 6 1992 9 9 9 rmn <br />