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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator a m o0 <br /> APPLICATION FOR — LAND USE — PERMITS 0 3. <br /> a <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 2 m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <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. w m <br /> James J. Oaon a o <br /> OWNER (Please Print) Contractor or Surveyor or Agent o <br /> 300 Dano. DAkve m <br /> Address Address <br /> BuhwSv2QQe, MN 55337 <br /> City, State,Zip Code City,State,Zip Code t <br /> (612) 890-1889 <br /> Telephone Telephone <br /> Emergenty/FIreNo. and RoadName <br /> Loi 36 First Addition to SeCma Lea AcAm, Sec. 30, T41N, R15G1, Town o� Sw(aa <br /> Legal Description (as Indicated on tax statement) <br /> G) <br /> Permit(s)Applied for: <br /> '^ r <br /> Dwelling Addition Filling/Grading Camping Unit o <br /> v <br /> Z 'o <br /> Accessory Building Sanitary X Privy Subdivision 0 a <br /> Garage /'�(c <br /> Structure Use: SanitaAy, —� "U I�� ml �"v-`�"�w _ o <br /> (family me/cabin, garage, addition,etc.) 14 <br /> G <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). 00 <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (OF). on3 v, <br /> 3. Show dimensions In feet of thefollowing:(a)buildingto all lot lines,(b)buildingto center line of road,(c)building aZ Q <br /> measurement to the ordinary high water mark of lake,stream,or river. o a <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m o <br /> dated by the owner. C = <br /> PLOT PLAN (A <br /> M W � = <br /> a : <br /> co <br /> n <br /> O <br /> SEE ATTACHED o = <br /> _ <br /> = I <br /> O y <br /> V <br /> m <br /> =_ 3$ m < '� m C u o 3 <br /> < . : O = ti) <br /> 0 f m� zr <br /> = v 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 /> a 3 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- m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ a $ <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- w <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have ro N m <br /> access to the above described premises at any reasonable time for the purpose of inspection. $ 0, <br /> n i v Ain : <br /> SIGN HERE <br /> Glade Ru ahotm 9128192 <br /> � a <br /> (signature of owner or buildin trac _— x <br /> r. <br /> ZONING ADMINISTRATOR ' <br /> TOWNSHIP PER ITS MAY BE REOUIRED SEP ^ x 0 m <br /> 888 9888rn <br />