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Burnett.Courity 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator (n "a o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3' 3' <br /> o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 3 c <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 /> Gary Marek $ ' f <br /> OWNER (Please Print) Contractor or Surveyor or Agent <br /> 10601 Silver Lake Road <br /> Address Address <br /> Grantsburg, WI 54840 <br /> City, State,Zip Code City,State,Zip Code <br /> (715)689-2476 joi� , <br /> Telephone Telephone I <br /> 10601 Silver Lake Road <br /> Emergency/Fire No. and Road Name <br /> txl. SE 1/4, NE 1/4, Sec.36 T38N, R18W, Town of Wood River, Burnett County <br /> Legal Description (as Indicated on tax statement) o <br /> 0 <br /> Permits) Applied for: o °_ c <br /> '^ r <br /> Dwelling Addition Filling/Grading Camping Unit o g <br /> v <br /> Z o <br /> Accessory Building Sanitary X Privy Subdivision o <br /> Garage ' f <br /> i <br /> Structure Use: Sanitary Only r <br /> y� o <br /> (family home/cabin, garage,addition, etc.) G� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) � <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). 0 <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). 3 m <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 `c <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 N' <br /> dated by the owner. <br /> C <br /> PLOT PLAN m - <br /> Q <br /> N <br /> I n <br /> see Attached. <br /> N <br /> 0 <br /> 0 <br /> o � <br /> N <br /> `t- Z <br /> ^I <br /> o c m w n c g m <br /> 00 am a M <br /> < = ' mo0. m' 3 <br /> O >; 3 T N M <br /> m <br /> G im c c <br /> g : a _ <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my know I. c m m 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 $ m g <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 /> 0 v <br /> access to the above described premises at any reasonable time for the purpose of inspection. m $ A <br /> m 3 <br /> '2 <br /> tn//gt a 8 <br /> SIGN HERE Wade R if�hnlm H a [ <br /> (signature of owner or bui Ing c frac t ( ate) <br /> ZONING ADMINISTRATOR <br /> TOWNS PERMITS MAY BE REQUIRED )n Go o 8 m <br /> 888888 $ $ '•" <br />