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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator a m 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 s.� w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. w m <br /> J) w V <br /> _pn nrx f� /ort C,/t n�P n f <br /> OVVNERYPlease/Prim l � ComraT Surveyor or Agent o A <br /> AddrPSA Address I <br /> C'0 m C <br /> Cl , Stat Zlp de City,State,Zip Code <br /> C-r'v m <br /> Te ^ T71 phone h <br /> Emergency/Fire No.and Road m <br /> Nae <br /> ., <br /> / � T v <br /> Legal Description (as Indicated on tax statement) /p-f-� r ,Or i t V,C-, Mr Cow- a <br /> �}Par"I 1^ 6ov, Cart 5<e,34(, <br /> < IYw. V.33'F .47, < <br /> Permit(s)Applied for: , t � � .. <br /> w r <br /> Dwelling Addition Filling/Grading �C�am�pi�nygg Unit S g <br /> Ys rooF �pnnYz:H w z <br /> Accessory Building Sanitary Privy SS bdiv ion ° m <br /> rage ' <br /> Structure Use: �' ^�, o <br /> (family home/cabin, garage, addition,etc.) , <br /> 1A <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 drainfieid (DF). a u <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building on `v <br /> measurement to the ordinary high water mark of lake,stream,or river. c n <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m m <br /> dated by the owner. C Z)Q 0 <br /> PLOT PLAN /V � �L <br /> �/ u�0%S (� s <br /> 40 <br /> C 0es'- Cctb)L . <br /> �I 0h .✓p't `-3 . o <br /> we <br /> 0.+ <br /> te0 n Rd 17ecl <br /> Y p c�rr PrM�t r' z <br /> _ D <br /> /1/115 �� � �� <br /> T 46 as 4 j ix CL Q ( �—"' u <br /> �� <br /> ./- be- n N rn v m r D D O 9 <br /> IK to <br /> 3 S�ru`y"�A z.z. ' c o <br /> Z $ MS : M <br /> o <br /> In <br /> In <br /> o� <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. ? o m `� ' m <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs: '� a m ` O <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 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. I 8 m <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 count fficials charged with administering county ordinances or other authorized person to have N <br /> O ' <br /> access to the above des re lass at any reasonable ime for the purpose of inspection. m 8 g <br /> B ^ypm <br /> APVM N p ! <br /> SIGN HERE (sig tur of owner o i9g contractor) x <br /> ZONING ADMINISTRATOR _(, '�� � S <br /> TOWNSHIP PERMITS MAY BE REQUIRED AUG Z 7 1991 'i �`u $ o o 8 m <br /> 88®88888y <br /> 1 <br />