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� 1 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator IJt l A o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> iv o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v w <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 3 Q <br /> regulations of the State of Wisconsin. H m <br /> LOth BeAAy n E <br /> OvyPNEERR (P ase Printl Contractor or Surveyor or Agent o <br /> 22989 County Road M <br /> Address Address <br /> GAantdbuAg, w1 54840 <br /> CiState,Zip Code City, State,Zip Code <br /> M-2479 <br /> Telephone Telephone UP <br /> 22989 County Road M <br /> Emer en y/ Ire No. and road ame ty <br /> payce� c�oveAnment La 1 , Vot. 314, Pq. 505, Sectlan 26, T38N, R18W, Town ofi <br /> Legal Description (as Indicated on tax statement) a0 Cv0i o <br /> � o � <br /> Permit(s)Applied for: 0 �- <br /> '^ r <br /> Dwelling Addition Filling/Grading Camping Unit S <br /> v <br /> Z o <br /> Accessory Building Sanitary X Privy Subdivision ° } <br /> Garage <br /> Structure Use: San(taAy Onty 5 <br /> (family home/cabin, garage, addition,etc.) <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) M <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). on v u <br /> 3. Show dimensions infeetofthefollowing:(a) bulldingtoall lot lines,(b)buildingtocenter line ofroad,(c)buildingZ `o <br /> measurement to the ordinary high water mark of lake,stream,or river. o Q <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 I <br /> PLOT PLAN w ul <br /> ulv <br /> C0N <br /> 0 <br /> 0 <br /> s <br /> SEE ATTACHED m <br /> o � <br /> N <br /> Z <br /> 9 <br /> G <br /> m <br /> a < H $ 0. m 3 <br /> N m 1 <br /> Nii G) [ O <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 � 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- m <br /> tion contained in this application(including any accompanying schedules and 1 further declare that I recognize that this infor- m 9, <br /> 9 m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 . .a $ 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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. "m 8 <br /> m 3A : <br /> SIGN HERE wade RU ,shohn <br /> (signature of o n or 'di ntractor) <br /> r <br /> ZONING ADMINISTRATOR <br /> TO NSHIP PERMITS MAY BE REQUIRED '1',1; Pub ^ 1 rn Tn rrn . ra o o HS m <br /> 888 8888rA <br />