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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 2m <br /> 71 located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 3 c <br /> Burnett County Land Use Ordinance, SanitatiCod no with all other applicable County Ordinances and the laws and _. <br /> re ns of thee,State o Wiyc�onssii/�/ �,,�/ N d <br /> O E (P ase PriContractor or Surveyor or Agent o 'm <br /> © m <br /> AddrTY <br /> City, State, Zip C de City, SIR,Zip Code I I <br /> MA/ � A- sl <br /> TeleTele hor-e— & / I _ r,2/9 Telepho117. - <br /> �g /z — <br /> Em rgency/Fire foo and Road Name F/tom <br /> Legal Description (a$indlcpted o tax statement) <br /> BIW 7 o_ <br /> Permit(s) Applied for: /zOVT (A 45e G 7 c6 W/ 7 5 0 <br /> L7 J <br /> Dwelling Addition Filling/Grading Camping Unit 0 g <br /> v <br /> Z. <br /> 0 'o <br /> Accessory Building Sanitary Privy Subdivision i $ d <br /> Garage / -1 <br /> Structure Use: /•�// o <br /> (familyhome/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). C o <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 11 <br /> c m <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building it Z `o <br /> measurement t the ordinary high water mark of lake,stream,or river. o n <br /> 4. If separate pla s are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m H <br /> dated by the o ner. C 03 <br /> I <br /> PLOT PLAN <br /> N <br /> M <br /> �d C <br /> 0 <br /> O <br /> o � <br /> �rP✓ S <br /> ) y <br /> O_ C ro d o Y <br /> v <br /> %v <br /> v N < ; Co <br /> Z m' o ? � � : <br /> O f M{q T N' 9 <br /> C <br /> 8 ` mm a <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- S 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 w m N O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation 1 am providing will be relied upon by ring County o urnett W' consin in determining whether to issue a permit. I $ m $ <br /> further accept all liability ich may be a r It f the C n of Bur relying on this information I am providing in this ap� N <br /> plication.I agree to pe county offi is ged w' a inist county ordinances or other authorized person to have u, <br /> m <br /> access to the above nbetl pro y rea n e time the purpose of inspection. $ <br /> OF <br /> M N 8 <br /> SIGN HEREIS <br /> H a E <br /> (si ture of owner or building c rector) (date) o Y <br /> ZONING ADMINISTRATOR _ <br /> H_ <br /> TOWNSHIP PERMITS MAY BE REQUIRED �u o . a m <br /> 888888 <br />