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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d o 0 <br /> f <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m U� <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 3 n <br /> relations of the State of Wisconsin. y <br /> LA�� l� , h3EQG y <br /> ✓ o <br /> OWNE (PleasePrint �� Contractor or Surveyor or Agent o <br /> $ o0 19 C o L.rzt <br /> Address Address <br /> Apple VAIIEv, rhe• 55124 <br /> City, State, Zip Code w oft< City,State,Zip Code L <br /> 1s12-- X32 yiS$O w WZ-841- 103°0 <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name <br /> 16927- zr.NEYzbr,eG RD• � <br /> Legal Description (as Indicated on tax statement) o `� <br /> C3 L) ? <br /> Permit(s)Applied for: <br /> o` < <br /> r <br /> Dwelling Addition Filling/Grading Camping Unit o <br /> v <br /> Z ' <br /> Accessory Building X Sanitary Privy Subdivision 0 m <br /> Garage <br /> Structure Use: G H2ACaE r <br /> (family home/cabin, garage, addition, etc.) <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: C <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). M C <br /> 2. Show the location of the well (W),septic tank (ST),and drainfleld (DF). 0 3 <br /> 3. Show the location of any lake or flowage-if within 1000 ft. and the location of any river or stream- if within 'I 'P <br /> 300 ft. z `c <br /> o n <br /> 4. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building � <br /> to lake, river or stream, if applicable. III o <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C , <br /> dated by the owner. �) <br /> PLOT PLAN Lo} L;ulg <br /> I t � <br /> co <br /> � t <br /> 1 t / I � 0 <br /> ( �^ o , ( Co <br /> t <br /> o <br /> r 1 <br /> 1 ILI <br /> 0 <br /> EL,rrrtfr�r8 <br /> ) <br /> Z<--- �co2 gLo_cq--k;oN o4 Sip}r <br /> 11`YYYY'( <br /> ---J E-------> In <br /> V1V'- CA, <br /> Aud 1J2A;w;;a1d. 9 -�aQi <br /> l kp a a•_ <br /> oza <br /> fm <br /> y "oS131/0 � <br /> Jnr ) }0 1 CC <br /> 8 { A m [ 70 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- ti S 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- y! d, p <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- g m N <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. <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- N <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have N <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 8 o E <br /> m3 n <br /> M : $ A a i <br /> CL� / H N 8 : <br /> SIGN HERE Z w n <br /> (s' n lure of ow uilding contractor) (date) <br /> ZONING ADMINISTRATOR g <br /> TOWNSHIPEyR^MITS MAY, BEc �REQUIRED g g n,±,± <br /> o m <br /> C(7 MON O� 1BYM�� / �Nyy� b, ILQS� IY1Ci/� /QY �o lJrOr^�cC7.I ggg888g8N <br />