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r, I r <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d _ ; o <br /> APPLICATION FOR — LAND USE — PERMITS 3' <br /> d <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 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. Hm <br /> TaNN M'- Tfill Rd STAGIC IAA\ rf <br /> OWNER (Please Print) Contractor or Sueyor or Agent o m <br /> � Z Ny R,���s Rv 913 Survmm ; .f ST, m <br /> Address Address 0 <br /> SjOaCAI , r_ SL1 6g S ?OorlCode IAI.[. Syual <br /> I Sta e,Zip Code City,State,Zip I <br /> ( /s4 �&-- Sy7� ('7rs) r, 3� - 7l vv <br /> elephdne Telephorle <br /> F. N. Izg�j ROSER7S RD, I� <br /> Em rgenc /Fire No. and Road Name //'' <br /> _ �E XL4 7 Yn N 13 11�/ U./ f`RDtlFRT 4QVT>1VN) <br /> Legal Description (as Indicated on tax statement) o <br /> c> <br /> Permit(s) Applied for: o °- <br /> STAIRS H <br /> Dwelling Addition Filling/Grading Camping Unit o <br /> v - <br /> Accessory Building Sanitary Privy Subdivision <br /> Z o <br /> Garage <br /> Structure Use: .® )36(i UiLO S'TA/R/i/AY FM Rn (LUK' iNb AREA 7D Du.�GL ANG r <br /> o <br /> (family home/cabin,garage, addition, etc.) <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). n <br /> 2. Show the location of the well (W),septic tank (ST), and drainfiaid (DF). 0 3 <br /> 3. Show dimensions Infeet of thefollowing:(a) buildingto all lot lines,(b)buildingto center line of road,(c)building MZ v <br /> measurement to the ordinary high water mark of lake,stream,or river. o a <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and n H <br /> dated by the owner. M fA I <br /> PLOT PLAN ( I(� LI - S L`TS <br /> M — <br /> S <br /> su <br /> N w 4 T R Ll' S IA/i? <br /> �t l081 2 - `-/'X61 0 <br /> L 4rIDi,l65 Z <br /> N <br /> L A?Hd f N <br /> 1-117C 6 <br /> ,1 '++,, <br /> 75 1 J lt N <br /> 2- 1YDiv6 02. <br /> �[ ). <br /> m <br /> 30 <br /> N <br /> y'rf�p z <br /> 6. <br /> J3 <br /> 'E6 to <br /> y 2, <br /> IGS \ �D o C m r n <br /> n m <br /> 12 0 �+�`n m = a o. m o m <br /> "4mi A�KyN / a 71 Z' m N 5, — C <br /> cm 561 <br /> _.. oB QTS - m <br /> moo : C <br /> m S <br /> g = € mm : a <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o � m <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ism <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 ; g a 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 N <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 0 <br /> m O A e <br /> m : m <br /> N w O <br /> SIGN MERE - f' <br /> Al <br /> i <br /> (sig ure o neror ng contractor) r_-� i-7�t 1 8 <br /> ZONING ADMINISTRATOR 8 : <br /> TOWNSHIP PE MITS MAY BE REQUIRED O� Q 199i (I 01� 8 �' . m <br /> I�' 88888 9y <br />