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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d 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 rl <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Land Use Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and 3 V <br /> regulations of the State of Wisconsin. w m <br /> c <br /> /tGin� r` m O <br /> OWN Please Prim <br /> ocJ��OYti1G- Contractor or Surveyor or Agent o m <br /> Zdb <br /> AIMAddress Address ) <br /> , Mr, S-5-14z-7 tri <br /> �iry,Stat ,Zip Cod City,State,Zip Code t <br /> (ol 2S 53 ? OROS <br /> Telephone Telephone <br /> 3/071 Rkcic l�r-1'✓e <br /> EmerncyTlre No. and Road Name \ t—p <br /> n�I$er n1's 1dZ (Trm—A 9 1 as dnss & ?JO <br /> Legal Description (as Indicated on tax statement) — o <br /> 9,I ry <br /> Permit(s)Applied for: Y <br /> Dwelling Addition Filling/Grading Camping Unit ° <br /> v <br /> z o <br /> Accessory Building Sanitary Privy Subdivision o m -v�'� <br /> Garage 1 e <br /> Structure Use: GC`b ^ a�d / 5� '^ -�""mac` �--) 2 sl�np" 4 roernS <br /> (family home/cabin, garage,addition,etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 9 <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 (",septic tank (ST), and drahtfield (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)building Z o <br /> measurement to the ordinary high water mark of lake,stream,or river. ° n <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and S 1 <br /> dated by the owner. C = <br /> PLOT PLAN (Mj( t S <br /> tj <br /> D,1rQ 3 w <br /> o <br /> OM <br /> N <br /> � o <br /> fd� Lo Nto <br /> o <br /> )) � <br /> t v� <br /> z° „u `f o <br /> X_ <br /> I� <br /> 'I <br /> D on C T m m aD, Q F ma <br /> O. Dff.G mGno z m M <br /> 2s2 0 m z : <br /> o ° -1 <br /> _ , Tei m <br /> C <br /> mom : c <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 5' I m <br /> edge and belief itis true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- — N m N O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- n <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 ; $ 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 i7, O <br /> access to the above described premises at any reasonable time for the purpose of inspection. $2 <br /> m <br /> SIGN HERE <br /> (signature of owner or building co r) ( at o <br /> ZONING ADMINISTRATOR /S g <br /> TOWNSHIP PERMITS AY BE REOUIRED 3 o o 8 m <br /> 88 $ $ 8888 '(' <br />