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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator a 'Vo 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 'Z w 1. <br /> — <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m t <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. H o <br /> h I�h'cPD 4D 10,99Es,L L� <br /> � a o <br /> O Ple e P in) Contractor or Surveyor or Agent o �, <br /> 0X' �o �asZ),y <br /> m <br /> Address Address <br /> Cf1�b55E 2 <br /> Cityeeeip CF. / City, State, Zip Code b <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as Indicated on tax statement) o <br /> O <br /> Permit(s)Applied for: o <br /> o` <br /> Dwelling Addition X Filling/Grading Camping Unit o <br /> v <br /> Accessory Building Sanitary Privy Subdivision ° g <br /> Garage 3 <br /> I / < <br /> Structure Use: 4M E foo F PlT�ti <br /> (family home/cabin, garage, addition, etc.) <br /> 0 <br /> 1A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). A <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). C 3 <br /> 3. Show dimensions Infest of the following:(a) building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinary high water mark of lake,stream,or river. o n <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. m i <br /> PLOT PLAN 0 1 <br /> M Z <br /> i <br /> cf <br /> Tv1 y <br /> O <br /> lagf aD Gdb-t^tj <br /> - r <br /> n <br /> dA <br /> T' <br /> t � <br /> q m <br /> o3m <br /> o '^ 0 m � <br /> F y : M <br /> c � m <br /> U ` mom : c <br /> 8 : m <br /> I 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 informs- y, m <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 g <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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. 05 <br /> m 3 8 <br /> SIGN HERE <br /> (signature of 9ppOr orildtng, ntractor) (date) <br /> ZONING ADMINISTRATOR ]"1 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED5yi <br /> � rni7�u' 8,'rin' oofSm <br /> Ift88888888rmif <br />