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Burnett,County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m (� <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 Code, and with all other applicable County Ordinances and the laws and 3 a --dregulations of the State of Wisconsin. m °_ <br /> Mr. and Mrs. F.J. Putzier JSV Construction a f <br /> OWNER (Please Print) Contractor or Surveyor or Agent <br /> 771 Fairmount rv. 1365 Uoodrich Av. rn <br /> Address Address j I <br /> Saint. Paul , 'in 'y5l 05 � 5 1 <br /> City, State, Zip Code City, Stat eZlp ode <br /> F�12-(oc�_t <br /> Telephone Telephone <br /> ''ire # 25022 Lakeview xoad rb <br /> Emergency/Fire No. and Road Name <br /> Lot 17 flat of hound Jeaeh Plat. - 1 <br /> Legal Description (as indicated on tax statement) <br /> cf <br /> Permit(s)Applied for: o �- <br /> m o � <br /> Dwelling Addition x Filling/Grading Camping Unit (�-- <br /> v r�, <br /> Z o 1 <br /> Accessory Building Sanitary Privy Subdivision P m <br /> Garage <br /> Structure Use: Lake Cabin r <br /> 0 <br /> (family home/cabin, garage, addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: <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). C 3 <br /> 3. Show the location of any lake or flowage- if within 1000 ft. and the location of any river or stream-if within 11 'R c <br /> 300 ft. 11 Z o <br /> o a <br /> 4. Show dimensions infeat of the following:(a)building to all lot lines,(b)building to center line of road,(c)building � y <br /> to lake, river or stream, if applicable. m I > <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C <br /> dated by the owner. M O <br /> m � <br /> PLOT PLAN N I <br /> c-'EkITER f INE, LAKEVIE` Ki v <br /> }�oPE-11z-: QIP c - �IOTEf A —D RO�J ✓ r Ja <br /> r �r In <br /> iV <br /> ° <br /> TE EE 13 Y_ m <br /> •w tea, �o BS AI 7OST <br /> epa <br /> I J <br /> w <br /> g0C � mm0a v <br /> m <br /> a = - <br /> H' : `� N O J d) <br /> Z d 0 m ,z i <br /> o f 21 u) m <br /> Ct N ' n o i <br /> m c C <br /> 8i a <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o ii m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <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. I 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 N ov <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 8 m <br /> A <br /> SIGN HERE <br /> 3-27-91 » € 8 : <br /> (si att ofowner wilding con actor) <br /> - I , 7C= 8 <br /> ZONING ADMINISTRATOR E <br /> I <br /> TOWNSHIP 04MITS MAY BE REOUIRLit <br /> ( I APR - 11991 !� N N N o o 9 m <br />