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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m o a <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c <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. w m <br /> ' <br /> f:f<Z eft ffy 4 n f <br /> OWNER (Please Prim) � / Contractor or Surveyor or Agent o �, <br /> JumtS E fe(cy 4n <br /> Address / R� Address <br /> GaBI ��o�n�✓r' <br /> City, State, Zip Code City, State,Zip Code <br /> W.ba ft'-, WJ -Y3y3 <br /> TelephoneTelephone n <br /> 71S- $/,G - 796 <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as Indicated on tax statement) r 1 <br /> CaK l 1'yo�u-�I��J <br /> Permit(s)Applied for: o °. <br /> 0 <br /> m � <br /> Dwelling Addition x' Filling/Grading Camping Unit o °- <br /> v <br /> 2 0 <br /> Accessory Building Sanitary Privy Subdivision ° $ <br /> Garage`/ ^^ �tt /J �tt <br /> Structure Use: SCS-[l nGd rn pdr(.A e d�wd 'fU (k k1n - no �1/,mb;ns <br /> (family home/cabin,garage,addition, etc.) + 1A I 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). <br /> 2. Show the location of the well (W),septic tank (ST),and dralnfield (DF). 3 <br /> 3. Show dimensions in feet ofthe following:(a)building to all lot lines,(b)building to center line of road,(c)building q Z c <br /> measurement to the ordinary high water mark of lake,stream, or river. o a <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. /J L M <br /> 31 <br /> PLOT PLAN - e[ �j �T r' - m ^C' <br /> J .Cc O� <br /> W <br /> CVA.� � ot'ef <br /> p - 0, <br /> "balms C ' " k) 11E /tip Cbt <br /> S <br /> O y <br /> SPre.� Cf�h SLY - �.r!✓w�clz� eS' rc�a�j (�tc� = �� <br /> z <br /> J <br /> AyErfi� (vL�OL�S l�6 ui7ro <br /> �i^te �q+tilc deck d prtca/krX &Lp^4, Y-o <br /> m <br /> .L 4` i �C� f I'GE !S Imo'-G4{'�. m <br /> Moll- (U ty)Akc�� C � �`J� (�tzcr« a � aam a <br /> i(flf` ` � A < , '0Z C ., 3 <br /> N . <br /> ELk Ircf Eo �E I^ �ry,ccc r{ G[[c( 55 C�/c P 6�� � Cc. [di•-to f6 ' mz : 1 <br /> lJ , : € m <br /> a € O <br /> Qi 8 m f a <br /> I declare that this application(including any accompanying 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 informa- (n m O <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- 8 <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 <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.1 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 m <br /> T I g n <br /> Lf I1 A u <br /> SIGN HERE 4 I / �� -- _ �pr, 'i <br /> (signature of owner or build'�contract --�-1 date) -._ {y ' o . x <br /> F1� nn N : . <br /> ZONING ADMINISTRATOR ( -"--- 8-. <br /> N_ <br /> TOWNSHIP PERMIT E REQUIRED o o m <br /> –APR--133 ssssss ' <br />