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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d 0 0 <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 m <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 3 a <br /> regulations of the State of Wisconsin. �, m <br /> Jerry Hansen Donald Daniels a " o <br /> f <br /> OWNER (Please Print) Contractor or Surveyor or Agent o <br /> 3172 170th St PO Box 316 <br /> Address Address <br /> Frederic WI 54887 Siren WT 54872 n m <br /> City, State,Zip Code City,State,Zip Code <br /> 715-1ao-22ro 715-84Q-�53� <br /> Telephone Telephone = <br /> a <br /> rD <br /> N <br /> Emergency/Fire No. and Road Name none <br /> Legal Description (as Indicated on tax statement) o <br /> Pcl in S13 T40N R15W Lot 6 Plot of Bonner Lake o <br /> Permit(s)Applied for: o < <br /> r <br /> Dwelling n It /Grading Camping Unit o °— <br /> v <br /> z o <br /> Accessory Building Sanitary x P ' Subdivision ° $ <br /> Garage / I <br /> Structure Use: <br /> (family me/cabi , garage, addition, ' c.) � rrV``J,, <br /> DIRECTIONS FOR PLOT PLAN DRAWING: C W <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). 3 <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 0 3 <br /> 3. Show the location of any lake or flowage-if within 1000 ft, and the location of any river or stream- if within 3 m <br /> 300 ft. Z Q <br /> 0 0 <br /> 4. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building (7 <br /> to lake, river or stream, if applicable. m o <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C I <br /> dated by the owner. m d <br /> PLOT PLAN <br /> See attached <br /> co <br /> W <br /> n <br /> 0 <br /> I� <br /> N tol.+ <br /> 0 t <br /> O y <br /> » <br /> Z <br /> I <br /> D fN co vCor- DD O -0 <br /> m 0' a� �- � a <br /> a <br /> M <br /> i G) o E O <br /> g c : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- S `� m <br /> and complete.I acknowledge that I am responsible for the detail and accuracy of all informs <br /> ,. <br /> m <br /> edge and belief n is true, licorrectpp Y ! to m v+[ o <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> j. mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g 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 a N <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> OP o <br /> access to the above descr' ed premises at any reasonable time for the purpose of inspection. <br /> m i 3 0 <br /> ry p h a <br /> ry A pA <br /> M N 8 : <br /> SIGN HERE �+ n <br /> (signature of owner or building c ac ., <br /> ZONING ADMINISTRATOR g [ <br /> TOWNSHIP PE ITS MAY BE REQUIRED JLJN — 3 1 8 Th <br /> J881 888 N <br /> I <br />