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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v v <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 <br /> regulations of the State of Wisconsin. <br /> WhTanenlng Pinea w <br /> o <br /> a <br /> F <br /> OWNER (Please Print) Contractor or Surveyor or Agent o m <br /> 71050 Whiwytino Pinea Road <br /> Ad ress Address C- <br /> FnedeAic, WI 54837 <br /> City, State, Zip Code City,State,Zip Code j� S <br /> 377-4707 <br /> Telephone Telephone ? <br /> 11050 Whl.arceAinq Ptnea Road <br /> Emergency/Fire No. and Road Name <br /> NW 114 SW 114 Sec, 72, T37N, R78W. Town ofi TA de Lake <br /> Legal Description (as indicated on tax statement) Y o <br /> n � <br /> Permits) Applied for: o 0_ <br /> o -- <br /> m � <br /> Dwelling Addition Filling/Grading Camping Unit °- <p <br /> Z o <br /> r <br /> Accessory Building Sanitary X Privy Subdivision ° <br /> Garage <br /> Structure Use: SanitccAy Ow°u <br /> (family home/cabin,garage, addition,etc.) E <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). n <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 3 <br /> 3. Show dimensions in feet ofthefollowing:(a)buildingto all lot lines,(b)bulldingto center line of road,(c)building an z <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 <br /> dated by the owner. C L <br /> I <br /> PLOT PLAN to <br /> m u�l <br /> co <br /> i <br /> Q <br /> m <br /> s <br /> 0 <br /> SEE ATTACHED. o <br /> Z <br /> ILQ <br /> A o c m d a y m <br /> > > 0 6 m <br /> �. D ane a' a <br /> a <2 .Z uCi90o <br /> z @@e 0 ,2 1 <br /> O Y T N D <br /> g ' m 0I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o L7 : 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- w m O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor r 3 u, <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 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.I 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. I m 8 A <br /> m 3 <br /> O [ 0 A w <br /> SIGN HERE g)ady <br /> (signal of owner 9rbuilding contractor) yda)e} vo <br /> ZONING ADMINISTRATOR <br /> MAR 3 0 1992 �^»» <br /> TOWNSHIP PERMITS MAY BE REQUIRED 8 oo i m <br /> _ :; 88888 N <br />