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Burfts:i County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS <br /> 0 <br /> TO THE ZOIJING 46MINISTRATOR: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 m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and o. <br /> regulations of the State of Wisconsin. y w d <br /> OWNER(Please P int) Contractor or Surveyor or Agent o 'm <br /> 4 It <br /> 7 (�"�` � tiY <br /> Ap� � <br /> r sr�1� Address <br /> l <br /> City,State, p <br /> Zi Code l� City, State,Zip Code <br /> L L 5I 2 £3�e t SSq Z I <br /> Telephone _ ru'� ,1 Tele hoe <br /> mer ency/Fire No. suip Road Name II <br /> Legal De ption ( s Indicated on tax statement) I Al <br /> Permit(s)Applied for: 0 �- <br /> �' r <br /> Dwelling Addition Filling/Grading Camping Unit 0 g <br /> v <br /> z o <br /> Accessory Building Sanitary Privy Subdivision ° } <br /> Garage - 1 <br /> Structure Use: 4 t f �,( r 1.IV <br /> � X-trq (.!X-cx'L .,,"� Co't'� I".J Y�S�G.K k- 5 <br /> —�,' (family home/catfin, garage, dition, c.) <br /> 1A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) F <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST),and dralnfleld (DF). 11 3 v <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building itZ Q <br /> measurement to the ordinary high water mark of lake,stream,or river. o o. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m o <br /> dated by the owner. C 1 <br /> PLOT PLA(�i I m <br /> � afu t <br /> f y <br /> { 1St 0 <br /> �[ R O <br /> c m <br /> f ' y <br /> i <br /> Z <br /> I / E Stow <br /> Yje uiou(� Gf/Xr< <br /> �, �� i7f✓b`' m o c � m m �a � 9 <br /> Ow Owns LUf As �i ��.�,r mim m M <br /> i Z OODO' M <br /> ate : ID <br /> g ` Am : a <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o 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 informs- _ x. «� O <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ m $ <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 N <br /> access to the above dascri4iRkpremises at an nable time for the purpose of inspection. m $ <br /> A <br /> SIGN HERE <br /> (signature of ow a or in c actor) r c to) <br /> ZONING ADMINISTRATORMZ <br /> N N y W N T <br /> TO NSHIP PERMITS MAY BE REQUIRED FPR I N N X o 025 m <br /> 88888888m <br />