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FJOVett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w - ii 1 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> d O <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v y U( <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. / _ o <br /> �f L Froud 8 / char-T., Sc / �+ o <br /> OWNERp(PleasePrint Contractor or Surveyor or Agent o <br /> � 7nClnc fir- <br /> Address Address <br /> � I � <br /> 1i~t t o h�e <br /> City, State, Zip Code City,State,Zip Code <br /> 2V�a - r3sr - �Y� 3 <br /> Telephone Telephone d ji <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as indicated on tax statement) o <br /> ° o <br /> Permit(s)Applied for: o <br /> Dwelling Addition Filling/Grading Camping Unit o = (1 <br /> Accessory Building Sanitaryse <br /> Privy Subdivision o 0 <br /> Garage N <br /> Structure Use: Sfti � iT� <br /> (family home/cabin, garage, addition, etc.) f�' � <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: � , <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). F <br /> 2. Show the location of the well (W),septic tank(ST), and drainfield (DF). 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. In Z PIS Q <br /> o n <br /> 4. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building C <br /> to lake, river or stream, if applicable. M 50 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. (A <br /> fn R > <br /> PLOT PLAN - <br /> 1 — 6 <br /> 7 <br /> � 3 � i 0 <br /> to) <br /> N <br /> Imo' <br /> 6 <br /> 7'j z <br /> 1� 'ae' e IQX�Y 13Y ' <br /> 'I LS <br /> dark ,Yes 7/ a <br /> Pi n <br /> I yTVYY(1 ha f�p�l rn � DRtv���le�s P cFn mD.Dy/ / Nr <br /> ,4 4 � a� z 9: o � <br /> eefo z m <br /> Do C : <br /> �Om <br /> M: <br /> Pe ►l ne0In <br /> 3 <br /> o <br /> g <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 9 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- .n m.n O <br /> PP (including Yaccompanying 1 9 `n ' �' <br /> tion contained in this application includin an schedule and I further declare that I recognize that this infor- o m u, <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g g <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 charg with administering county ordinances or other authorized person to have <br /> access to the ve described premises at any rasonable time for the purpose of inspection. m g o <br /> m 3 s <br /> A <br /> SIGN HERE —�� _��/ m g ' <br /> (signature of ter r building contractor) (date) <br /> o : F, <br /> ZONING ADMINISTRATOR g ' <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> N (pNI N OO pO O T <br />