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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 a o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. ' <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c J <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 /> reeguullations of the State of Wisconsin. <br /> l/ <br /> OWNER (Please dnt) Contractor or Surveyor or Agent m rV <br /> r7 7SS_/ "i iY>< TLohd /lis i DZr t, 7rrr I 'l <br /> Address AcIess <br /> �s4;Fr . IV_1 S'Y)r93 V"1-iV, 14/ <br /> City,State,Zip City,State,Zip Code <br /> F1'66 -lyB'9.S <br /> Telephone Telephone <br /> .275/3 VrA1 <br /> E argency/Fire No. and Road Name <br /> r, Lo r / . J e r e2 See. 311 W n/ IS'kl � <br /> Legal Description (as Indicated on tax statement) <br /> C <br /> A <br /> Permit(s)Applied for: 0 0 <br /> w 0 <br /> Dwelling Addition )< Filling/Grading Camping Unit a °^ r` <br /> v <br /> Z o 3 <br /> Accessory Building Sanitary Privy Subdivision 0 $ <br /> Garage , 6 <br /> Structure Use: ��r"''A l a X 02/ r a2 S°Z �q F ( /i i f;ed') o 1 <br /> (family home/cabin,garage,addition, c.) <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 draintield (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 Z <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and — H: <br /> dated by the owner. / C <br /> PLOT PLAN O 0,•7� f (�? <br /> � � C <br /> reeAj <br /> 0 <br /> /Zxs.IN o <br /> rit 3S-r 4 y/c s So z <br /> D f <br /> c �l <br /> 3oz / <br /> In <br /> eco <br /> r o i Co M <br /> JOv . Sy eree� 6+l�e � �'�9) iE o <br /> I declare that this application(Includiny accompanying schedule)has been examined by me and to the best of my knowl- : g <br /> �8rt m <br /> edge and belief it is true,correct and cKlete.I acknowledge that I am responsible for the detail and accuracy of all informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. 1 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 n o <br /> access to the above described premises at any reasonable time for the purpose of inspection. , 0 89 <br /> B € A n : <br /> SIGN HER jig' ` a <br /> (si <br /> tur6 of ow r or building contractor) , <br /> IL] g <br /> R.�„�.-.. o <br /> ZONING AD INISTRATOR ` "•` _--'_ V <br /> « <br /> TOWNSHIP PERMITS MAY BE REQUIRED i11991 $ )� o o O m <br /> 88888888vmi <br />