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Burnett County 7410 Co. Rd. K, #102, siren, W1 54872 Office of Zoning Administrator d -- z <br /> APPLICATION FOR — LAND USE — PERMITS 3 �I <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m r <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- - W -1- <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- <br /> tions of the State of Wisconsin. <br /> Karen S. Pate Chuck Spelbring/Bay Park Construction a = 0 1\ <br /> OWNER(Please Print) Contractor or Surveyor or Agent 1E <br /> 825 Ridge Place Route 2 d <br /> Address Address .` <br /> Mendota Heights, MN 55118 Trego, WI 54888 cQ <br /> City,State,Zip Code City,State,Zip Code <br /> (612)452-1558 (715)635-2840 <br /> Telephone Telephone <br /> Permit(e)Applied for. <br /> New Building XX Filling/Grading <br /> Addition Moving <br /> Sanitary Camping Unit 0 <br /> 0 <br /> Privy Subdivision 0 <br /> �' r <br /> Structure Use: cabin ° g <br /> v <br /> (family home/cabin, garage,addition,etc.) 0 0 <br /> 9 <br /> N <br /> Directions for plot plan drawing: "tom <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 drainfield(DF). <br /> 3. Show the location of any lake or flowage-if within 1000 ft.and the location of any river or stream- if within 300 ft. o <br /> 4. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building to lake, <br /> river or stream, if applicable. <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and dated by <br /> the owner. 6. Provide legal land description. 1 _ O <br /> PLOT PLAN J.1,rF MRNI.-C- ���,�G' _ 3 <br /> I y rn t{YG� 7-/0 Cn <br /> -7:5 o n <br /> � o <br /> I � <br /> Burne <br /> u, <br /> I ,' �ac�d.� o <br /> NQ <br /> . <br /> q ` <br /> �lLit7r .rur'IX Its <br /> S <br /> �Dr4l� ) w4� �LN57r <br /> eld �u�� z <br /> 0 <br /> f lr:oG�`s 1 mb <br /> o0d5 <br /> t <br /> 47 + <br /> r hi <br /> \ � (% USS wSe — ,Ivim <br /> 1 17- <br /> 1 n r 1,4 C'\)� ��(J j � J U CL C 1'� +,(7"k F i <br /> m n a m a'A <br /> u;Id+h �!r' hovSr✓ a N o <br /> Z y 0€ "z : <br /> sn ' o <br /> _ m <br /> se �v Xb� n",; l" _ 61 �� p <br /> ' — <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that A p <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a o <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized n <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> SIGN HERE <br /> (si pre of 6 er or b 'ilding c ntractor) (date) <br /> p <br /> ZONING ADMINISTRATOR-���1�.zJ <br /> L N N O N N T <br /> ;;TOWNSHIP PERMITS MAY REQUIRED <br /> 00000 9 <br />