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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator in ' o <br /> APPLICATION FOR - LAND USE - PERMITS3. <br /> m 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 2 <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 3 n <br /> regulations of the State of Wisconsin. �, m <br /> Luther Point Bible Camp Self a <br /> 9 F <br /> OWNER (Please Print) Coltti �orLStr�r �r rY�int Road m° <br /> 11525 Luther Point Road <br /> m <br /> Address Address <br /> Grantsburg, WI 54840 Grantsburg, WI 54840 ) — <br /> City,State,Zip Code City,State,Zip Code <br /> ( 715 ) 689-2347 ( 715 ) 689-2347 (O <br /> Telephone Telephone <br /> 11525 Luther Point Road <br /> Emergency/Fire No. and Road Name <br /> Burnett County, Lot 6, Section 34 , Township 38 North, Range 18 West cs <br /> Legal Description (as Indicated on tax statement) o <br /> Q <br /> Permit(s) Applied for: o °. <br /> 0 <br /> m � <br /> Dwelling Addition Filling/Grading Camping Unit <br /> v <br /> Z o <br /> Accessory Building X Sanitary Privy Subdivision_ <br /> Garage L <br /> 1-1 <br /> Structure Use: <br /> Shop & Storage Building 30 J~lo �1d� <br /> 5 <br /> (family home/cabin,garage,addition, etc.) - <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). o <br /> 2. Show the location of the well (W),septic tank (ST),and drainfleld (DF). C 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 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 <br /> dated by the owner. C Sv <br /> PLOT PLAN -/ 4t)O/',s(� 0 m q <br /> o <br /> Ll <br /> o � <br /> Z <br /> I C <br /> IhQ/pv To Li1fE 45c�lAt �sr[ p <br /> J,N�/ Ls r/v f�FR o All C9i-Nj�iP m oc -° nmoaE a <br /> m -a'd 's 'am a m M <br /> P fes : : a <br /> Z�- � i m <br /> G) o <br /> C <br /> m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- o. m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- m 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 thts ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O o <br /> access to the above des ribed premises at any reasonable time for the purpose of inspection. m <br /> m 3 <br /> a O r a <br /> SIGN HERE <br /> (signa-t�ur'eI'�of owner or building ontractor) (dale) <br /> ZONING ADMINISTRATOR �f rT ^Ind 8 i <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 8. 00 <br />