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Burnett County 7310 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ' -0 o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d o <br /> TO THE ZC NING 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 ^ m <br /> Burnet)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. / H o V <br /> E,y �DBSDitI (�� z� /.Z�G� �•L�S/ a / 11 <br /> OWNER (PI ase Print Contractor or Surveyor o ent o 1 <br /> A dres <br /> 1.2fl dress <br /> City,State,Zip Code City, State,Zip Code <br /> Telepppone Telephone <br /> l�/2— %32 <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as indicated on tax statement) ° ry <br /> o <br /> Permit(s) Applied for: c :- <br /> N <br /> Dwelling - Addition Filling/Grading Camping Unit 3 <br /> v <br /> Z o J <br /> Accessory Building Sanitary Privy Subdivision P <br /> Garage <br /> Structure Use: ti Aic L r' o <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 o <br /> 2. Show the location of the well (W),septic tank (ST), and drainfiaid (DF). 3 u, <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)buildingZ `o <br /> measurement to the ordinary high water mark of lake,stream, or river. o n <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m laml ,, o <br /> dated by the owner. C 0 <br /> PLOT PLAN <br /> m <br /> 3 � <br /> � : <br /> o <br /> o <br /> T - u <br /> - o <br /> f 3 a .2� <br /> m 076i \ v <br /> x»17&) i <br /> rn .0 mr DD p V <br /> N w n a On <br /> a <br /> q < z m o 0. m 3 <br /> Z m o 0 .2 1 <br /> O <br /> — [ m <br /> g <br /> m _ C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my,formaknrowl3 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- <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 g 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 ap- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have m e0 <br /> p i <br /> access to the above described premise t any reasonable time for the purpose of inspection. <br /> m 3 <br /> SIGN HERE V <br /> (signature of owner or buildin contractor) <br /> n, <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED u N o o fS m <br /> DEC 51991 j� 8889988N <br /> �1 u <br />