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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q H <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. m , <br /> Denw'r.n A. Robett O n A f <br /> OWNER (Please Print) <br /> 1450 S. W"wn Lane #107 Contractor or Surveyor or Agent o <br /> _ <br /> Address Address <br /> Riveh FAf2s. W1 54022 <br /> City,State,Zip Code City, State,Zip Code 1 <br /> (715) 425-2352 I� <br /> Telephone Telephone v " <br /> Emergency/Fire No. and Road Name <br /> pct.. NE i/4 NW 114 Sec. 7. T38N. R15W. Torun nb IaFn Aot.ty _ <br /> Legal Description (as Indicated on tax statement) o <br /> Permits)Applied for: o <br /> o (� <br /> o - <br /> '^ r <br /> Dwelling Addition Filling/Grading Camping Unit o ° <br /> v <br /> z a <br /> Accessory Building Sanitary X Privy Subdivision P <br /> arm age <br /> Structure Use: Sanitmy 0nPjj _ <br /> (family home/cabin, garage,addition,etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) C <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 wello <br /> (W),septic tank (ST),and drainfieltl (DF). 3 <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building 11 z v <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 O N <br /> dated by the owner. M o <br /> — C <br /> PLOT PLAN m <br /> l I <br /> m <br /> 1 � <br /> 0 <br /> SEE ATTACHED. m <br /> o y <br /> N , <br /> Z <br /> 1 ` D <br /> f <br /> o c m m � c g m <br /> m'd0 - ]1 <br /> N Co 3 m <br /> O O <br /> m <br /> Q <br /> 8 = <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl' S : mit . m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- «m 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 9 ? 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 ut <br /> access to the above described premises at any reasonable time for the purpose of inspection. m g <br /> T i 3 n <br /> 0 D A N <br /> SIGN HERE Wade gu4Ahn-frn <br /> 4/14/92 a ` <br /> a <br /> (signature of owner or building contract r) � Ida <br /> r <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS WY BE REQUIRED 8 c,o 8 m <br /> 9 888MW <br />