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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 0 <br /> IE <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 0 <br /> TO THE ZONIN a ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <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 _ <br /> regulations of the State of Wisconsin. c <br /> OWNER lea e P int) Contractor or Surveyor or Agent �j m m <br /> Ad Ss Address_ <br /> a��nnmrt 1 � 3 <br /> xSoc�Ler W IS sy80/ CD <br /> City, State,Zip C de f City,St te, Zip Code <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as indicated on tax statement) <br /> n_ 0 <br /> 0 <br /> _ <br /> Permito y.s) Applied for: � <br /> '^ r <br /> Dwelling Addition Filling/Grading Camping Unit E o <br /> v <br /> = o <br /> Accessory Building Sanitary Privy Subdivision o } <br /> Garage <br /> 1 O>'c_{'1 I[% ' / Awtox 1 - r�PlKflYUI I��i i�` r <br /> Structure Use: 1: l 9 <br /> —II <br /> (family home/cabin,garage,`addadd ition, a o.) � <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 dralnfield (DF). I o 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 11 = Q <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 n <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and N <br /> dated by the owner. C 0 <br /> PLOT PLAN w <br /> i <br /> ��Ja G <br /> See OCU <br /> m <br /> w� a ti I VV� <br /> o <br /> CI� <br /> A> sure c <br /> o c T d m a V MM <br /> m <br /> m, N )i `$ M <br /> _ . � . <br /> .0 10 <br /> o 0 '. ° = rni m <br /> � 2 C <br /> mI declare that this application(including any acco mpanying schedule)has been examined by me and to the best of my knowl- o 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- a m w <br /> tion contained in this application(including any E rccompanying schedule)and I further declare that I recognize that this infor-mation I am providing will be relied upon by thea County of Burnett Wisconsin in determining whether to issue a permit. 1 g m $ <br /> further accept all liability which may be a result()f the County of Burnett relying on this information I am providing in this ap- <br /> plication.I agree to permit county officials chart led 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 M 8 N <br /> N H O <br /> SIGN HERE <br /> al a of owner or bui contractor, (date) o x <br /> ZONING ADMINISTRATOR <br /> WBE REOUIREDIJ ~ 8 8 9 In <br /> ,t <br /> 88888 $ 88ra <br />