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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U � c I o <br /> IE <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v H S <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and a <br /> regulations of the State of Wisconsin, m d <br /> m <br /> Jorves J. Kady m o <br /> n f <br /> OWNER (Please Prim) Contractor or Surveyor or Agent o <br /> 3308 W. 159Th St. m <br /> Address Address <br /> CKexe&nd, UH 44111-1946 <br /> City, State,Zip Code City, State,Zip Code <br /> 1216) 941-9004 <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name <br /> SE 1/4 NE 1/4 Section 18. T38N. R15W. Thum o4 LaFoftette. BuAnott Coo ntU <br /> Legal Description (as Indicated on tax statement) o <br /> n O <br /> 0 <br /> Permit(s)Applied for: o <br /> o <br /> '^ r <br /> Dwelling Addition Filling/Grading Camping Unit o °– <br /> v <br /> Z o <br /> Accessory Building Sanitary X Privy Subdivision ° <br /> Garage <br /> Structure Use: San2taAU Onty <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). 9 <br /> 2. Show the location of the well <br /> (W),septic tank (ST), and drainfield (DF). 3 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 1 Z v <br /> measurement to the ordinary high water mark of lake,stream,or river. A o n <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plana must be signed and LA <br /> dated by the owner. C G o rn <br /> i <br /> l` <br /> PLOT PLAN m <br /> C� <br /> I <br /> d `\ 1 <br /> 1 <br /> Ul <br /> Q n <br /> V O <br /> 0 <br /> SEF ATTACHED o <br /> m_ <br /> IOQ <br /> Z <br /> U) <br /> G <br /> a Nfn � NrDD p � <br /> m ' <br /> N° 71 <br /> D a a n <br /> 9 m < m C 0 m O ff ; <br /> E G N : m <br /> g m m S <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- c 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 1 am providing in this ap <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have u, <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 8 m <br /> m A N <br /> SIGN HERE Wade RUAhhotm - r i _. e1-10192 �' m <br /> (signature of owneLgebut n c tor) (da <br /> ZONING ADMINISTRATOR <br /> O �� s E E <br /> TOWN HIP PERMITS MAY BE REQUIRED WG ' ' I o o m <br /> 9 8888N <br />