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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator (n m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and H <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the `^ m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3. n <br /> regulations of the State of Wisconsin. <br /> `Dv / <br /> CRR15GIMM CAROL CAALLA5 SI?I_r a f <br /> OWN R (Please Print) Contractor or Surveyor or Agent <br /> 57 i RID(.E CREEK RD. t <br /> Address Address <br /> SNOF'EV 1 -%A/ j M4 55126 v <br /> City, State, Zip Code City, State,Zip Code <br /> 78 (o <br /> Telephone Telephone Telephone V)- <br /> ►.)UNA(I,A APPUE,O FDK �o I" FIL ESS 6.j I�tKGN lSLA^ D DRIllE- <br /> Emergency/Fire No. and Road Name <br /> CSM LDT A VOLUME. 11 TALES 5 . IOy Ajo It <br /> Legal Description (as Indicated on tax statement) <br /> n 0 <br /> 0 <br /> Permit(s) Applied for: 0 <br /> 14 <br /> o <br /> Dwelling Addition Filling/Grading Camping Unit <br /> v c <br /> Z 0 <br /> Accessory Building Sanitary Privy Subdivision o } 3 <br /> Garage <br /> Structure Use: C A 611,4 o <br /> (family home/cabin, garage, addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: X <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). o o m <br /> 3. Show the location of any lake or flowage- if within 1000 ft. and the location of any river or stream-If within <br /> on z 0 <br /> 300 ft. 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 m H <br /> to lake, river or stream, if applicable. ° <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C r <br /> dated by the owner. n I S <br /> PLOT PLAN Pn f q-333 SCALE l rl- 150" I <br /> 1 l C <br /> io8o , v7 v <br /> r0T <br /> FUTURE- CA6114 <br /> \ - Z. <br /> D <br /> � E,rfyr,Ny q�• <br /> �` lo�Xlo'DI-v4 t �1' <br /> '^ ISL-A 114P <br /> LAKE = � mm >Vm <br /> ofe prl UPway .feI M�ef �rd,h�nre aa� a <br /> ffr �V17 C IPrti`�nce �/ / / / r 21 <br /> z z 1 <br /> S L IY�S �C W. Gl;rNO�T (Oma/C Jh�i y o E <br /> / r7Y�rf m <br /> r^Ke tfre 6v/um6�9� 4'—. m <br /> I declare that this application(including any accomparfying schedule)has been examined by me and to the best of my knowl- o R <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible forthe detail and accuracy of all informs- c <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue apermit. 1 <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 o <br /> access to the above describ d premi as at any reasonable time for the purpose of inspection. ro $ m <br /> m [ 3 0 <br /> m a yin <br /> m m <br /> SIGN HERE <br /> (sig ure of ow er or u'Idi ontractor) ld L ` / % o x <br /> ZONING ADMINISTRATOR `((�� <br /> TOW SHIP PERMITS MAY BE REQUIRED <br />