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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> 0 <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 mom, <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 0_ <br /> regulations of the State of Wisconsin. w m <br /> 1�v� 1 1 a o <br /> OWNER (Please P i Contractor or Surveyor or Agent <br /> Adress ' Address <br /> _, ,_S�• �Au G , ObJA �S07S <br /> City, State, Zip Code City, State,Zip Code I ,� <br /> Tele ho Telephone <br /> Emergency/Fire No. and Koad Name <br /> Legal Description (as indicated on tax statement) <br /> n L7 <br /> Permit(s) Applied for: o °. <br /> Dwelling Addition X— Filling/Grading Camping Unit o <br /> v <br /> Z <br /> V <br /> Accessory Building Sanitary Privy Subdivision ° <br /> Garage T <br /> Structure Use: ja '� j lN� ��/A� 12'/1/e o – <br /> (fami home/ca in, 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). o <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). 3 <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)buildingq z c <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 m H. <br /> dated by the owner. <br /> o,l C <br /> ///��� <br /> PLOT PLAN ^ '1 0 o f _ /a - to C <br /> / L / l � to <br /> J <br /> GR C <br /> o <br /> Rq�t.,�-- <br /> �� <br /> m <br /> P <br /> y <br /> CwocYQ oIC� , bu� an <br /> o c v m o a F m <br /> m va� mam amy <br /> 05 . ,2goo = m3 <br /> F T� M <br /> N ` m <br /> m � C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know) 4 : m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs a m N O <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- rn $$�'m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 VX ': 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 to have N <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 8 m <br /> n <br /> SIGN HERE <br /> wner or ui 'ng contractor) (date) c x <br /> ZONING ADMINIST7;E <br /> 8 <br /> SHIP PERMITS MAY BE REOUIRED <br /> 88888888 (mn <br />