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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Z <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 n C <br /> regulations of the State of Wisconsin. <br /> hae-k f 1• Fnk N)r ro In <br /> OWNER (Please Print) Contractor or Surveyor or Agent o <br /> .2 iz � .r�6�•.e 6A� A-v� <br /> Address Address 7 <br /> S`1- ?auj /1,1 <br /> City, State,Zip Code C ty, State,Zip Code } <br /> sal (q <br /> Telephone Telephone <br /> X38 49 -7 �> <br /> Emergency/Fire No. and Road Name <br /> 2929! Foe4 <br /> Legal Description (as Indicated on tax statement) o <br /> Prz spm 'ZOr 1 o!- 4olv - isw <br /> Permit(s) Applied for: 4S' /- ei 5- oC� o °- 0, <br /> 0 <br /> Dwelling Addition Filling/Grading Camping Unit S °— <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision ° <br /> Garage <br /> Structure Use: PA#10 '4_'/4'/0FL'EE CAI EX1S-h'19 P+f/ro 'X'1Qr <br /> (familyhome/cabin, garage,addition, etc.) � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) C <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). 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 41 Z <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 H <br /> dated by the owner. <br /> C <br /> PLOT PLAN 1 µf / I m <br /> S R 8 e Sbcd C <br /> Eft to <br /> _ C <br /> OL)-r 140vre <br /> t N <br /> V% n <br /> 0 <br /> o <br /> v /3"nk ?. <br /> O lie'S <br /> O y <br /> /or y T . <br /> / i 61 <br /> V 4E� <br /> � O o r z <br /> � <br /> y ~ o✓mss H �„y Pktr� <br /> rerx z¢r � <br /> F f�A�1.1 bT Doc mmnn m <br /> cw m — a.� anm aW y <br /> F 00 8 In <br /> iAl t < o f a <br /> � . . <br /> to <br /> i <br /> It that t 's application(including any accompanying schedule)has been examined by me and to the best of in knowl o 0 Z : In <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- w> O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. 800 Mmation 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 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 0 f <br /> m 3 O . <br /> ro [ v A " <br /> N <br /> SIGN HERE rO 41 <br /> (signs re of caner or i ng contractor) c x[ <br /> ZONING ADMINISTRATOR I Mw ??p 8 <br /> I VV I MN <br /> TOWNSHIP PERMITS MAY BE REQUIRED u, u, a rn <br /> 0,8 o 8 o 9 S' m m <br /> 8888888vi <br />