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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m '1 0 0 <br /> JE <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> a <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 3 ,� <br /> Burnett County Land Use Ordinance,Sanitation Cade,and with all other applicable Courtly Ordinances and the laws and _ <br /> �re ulations of the State of Wisconsin. <br /> �G� J-4 YEP, S SLE m m o <br /> )Q(NER jPlea�PPlirlt) Contractor or Surveyor or Agent m <br /> �(Jx <br /> Sr _O ' W i � Address <br /> Pd(1re <br /> (Ci J,State,Zip.Codd City,State,Zip Cade pQ <br /> LSI y <br /> Te h e r Telephone <br /> nj!�E� PJILLE 2 RD _ <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as Indicated on tax statement) <br /> 0 <br /> Permit(s)Applied for: o <br /> mm <br /> Dwelling itierr— illinglGrading Camping Unit <br /> v <br /> Z c <br /> Accessory Building Sanitary Pri Subdivision P <br /> o <br /> Garage <br /> Structure Use: <br /> (family home/cabin, garage,addition,etc.) <br /> 1A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 9 <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 drainfleld (DF). in in 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 g <br /> measurement to the ordinary high water mark of lake,stream,or river. o <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and A N <br /> dated by the owner. C <br /> PLOT PLAN m L (� <br /> c \� <br /> o <br /> N <br /> 0 <br /> � LN <br /> O � <br /> N IIIIYu��r' <br /> r I <br /> Z <br /> n <br /> m o o m r o a g m <br /> g2. : .Z Co Oro ; <br /> Z o Z : <br /> O <br /> � [ m <br /> 8 i 'm c c: g;: m <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- w m gg!: O <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i 8 ro iX f <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I i 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 10 have e for the purpose of inspection. m g <br /> access to the above described premise at any reasonable tim8 X <br /> 8 ^ " <br /> SIGN HERE x <br /> (signatije of owner or building contractor) (date) c <br /> ZONING ADMINISTRATOR i' <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> $ $ 888ra <br />