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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m o` f o <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 <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 appli�ble�y�re�tnanea and the laws and 3 n J <br /> regulations of the State of Wisconsin. w m 11 <br /> =sdLel/m /4�i� �1�I1/f/S' Juc�Pd - ^ o <br /> F <br /> OWNER (Please Pri t) i ontra r or Surveyor or Agent v m <br /> .22o6e <br /> Adtlress Address <br /> !�! 0-j L4.1 f 1�ate Cel� L <br /> City, State, Zip Code City,State,Zip Code <br /> -Q 3 — a30C <br /> Telephone Telephone 1 <br /> Emergency/Fire No. and Road Name p i �J <br /> Legal Description (as indicated on tax statement) <br /> T .xp w.;e LoTJ/ta i3�oG�oZ Lv uO•d'.!!lh2f svlD�✓ld�i+, o <br /> Permit(s) Applied for: o �- <br /> Dwelling Addition ✓ Filling/Grading Camping Unit S g <br /> v <br /> z o <br /> Accessory Building Sanitary rivy Subdivision ° <br /> Garage <br /> Structure Use: t t C �.J .�lu/I�D �ONilfb r <br /> (family home/cabin,garage, addition,etc.) <br /> 71 II/�rtr- <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). 00 <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). D3 n <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 <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 o <br /> dated by the owner. <br /> 1 = <br /> PLOT PLAN <br /> Cn <br /> —C '1 wAdr <br /> r . <br /> NS 0 l -. <br /> o � � <br /> r P1 <br /> t... n <br /> \ z <br /> EB— 1oxnf' �/.y Ah1 w��. <br /> NB• WX s*' (NQ) 7a "r 1-:Z9S <br /> IfiryKIFEO B'►MrA� �17f i �o.,� NiwrY yam' <br /> Sours! /LO' 1 ; g F <br /> 11NW4 r1riu�N IYIW, 47ESr— (.L3 ' W <br /> 75 L� al�r�m. o�aoov _ 2 € : <br /> S � � C <br /> m 1= : I c <br /> 8 : �W ' 53 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knows- <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- H m¢!: O <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 g m $ <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 i7 0 : <br /> access to the above described premises at any reasonable time for the purpose of inspection. $ <br /> 3 n : <br /> SIGN � - <br /> (signature of er or ildin co tractor) <br /> I (d c ? x <br /> ZONING ADMINISTRATOR g ` <br /> . M <br /> T WNSHIP PERMITS MAY BE REQUIRED I) APR — 9 IM <br /> I10 X88888 <br />