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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m /4 o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes .. ° <br /> 9 by application for a Permit for the work described and ie <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 $ <br /> regulations of the State of Wisconsin. mn <br /> /1/e i L E-, N d rt i n, a <br /> OWNER (Please Print [ 1. / Contractor or Surveyor or Agent o <br /> // 7,F-E-L ' reit 1 fes. m <br /> Ad ,eAddress ` <br /> 04 _S M✓) {537 <br /> City, State,Zip-rode city,state,zip Code <br /> Telephone1� <br /> .,OL k j Telephone <br /> o?a 84� ax4„ � <br /> Emergency/Fire No. and Road Name Q` <br /> Legal Description (as Indicated on tax statement) o <br /> Permits)Applied for: `^ o �- <br /> O ` <br /> N <br /> Dwelling Addition Filling/Grading Camping Unit o <br /> v <br /> Accessory Building Sanitary Privy Subdivision . 9 <br /> Garage ,,// J �^ <br /> Structure Use: 09m Pe t(' #-6 r Cp <br /> (family home/cabin,garage,addition, etc.) °^ <br /> 1A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) C <br /> 1. Show the location and size of all existing buildings (ES) and all new buildings (NB) and Indicate North (N). 9 <br /> 2. Show the location of the well (W),septic tank(ST), and dralnfield (DF). 0 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 e <br /> measurement to the ordinary high water mark of lake,stream,or river. c a <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and w <br /> dated by the owner. o <br /> C <br /> PLOT PLAN N <br /> m <br /> b1 = <br /> /50 6�1 <br /> lU <br /> m <br /> o <br /> w <br /> r <br /> G C ro m n d V m <br /> m m <br /> v ag� maN � A 9 <br /> � CmoNm 3 <br /> o g it zt <br /> m <br /> oma € C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- m os O <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 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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. 8 <br /> J� $ 0 <br /> SIGN HERE ✓ S s �� m <br /> (sig ature of owner or building contractor) (� (� /7 <br /> ZONING ADMINISTRATOR f / <br /> L5 fl 1J x <br /> TOWNSHIP PERMITS MAY BE REQUIREDEL MAY 20 1992 c m <br /> 888 98tmn <br />