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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ) 'a 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 'Z j G <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 a <br /> regulations of the State of Wisconsin. o <br /> n'T"' `c° O <br /> OWNER (Please PrirSt) Contractor or Surveyor or Agent o m <br /> 4irn �P AiS/ S ��� . ,l�. r �vsr A -� <br /> Addre <br /> Lo ks <br /> City, State, Zip Code 6'5,141-3 City, State,Zip Co i <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name ` 1 <br /> c <br /> Legal Description (as Indicated on tax statemen ) Qod � T'1S�3 7'/✓/0 NL <br /> T6 ' T <br /> Permit(s)Applied for: /S o <br /> m <br /> o <br /> o < <br /> m r <br /> Dwelling ✓ Addition Filling/Grading Camping Unit o `± <br /> z T <br /> Accessory Building Sanitary Privy Subdivision ° <br /> Garage <br /> Structure Use: A/4rn i L.. Vii?? e r <br /> (family home/cabin, garage, addition, etc.) ° <br /> 1A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). M O <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). 0 3 <br /> an 3 <br /> 3. Show dimensions In feet ofthefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building c <br /> measurement to the ordinary high water mark of lake,stream,or river. o n <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m y <br /> dated by the owner. <br /> PLOT PLAN <br /> o <br /> N <br /> P <br /> M d <br /> c � + � b <br /> r m <br /> x <br /> � <br /> 01UJIV` ry a F O <br /> m <br /> 4' <� m' c H o 3 <br /> z N : o � m � <br /> O <br /> N , m <br /> r ri-sic--� » ' <br /> g 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 informa- e,ro H M <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. I . m g ; <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 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 0 o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m g m <br /> A e <br /> SIGN HERE <br /> I w <br /> _._.-__, <br /> 't w i <br /> (at at a of o or building contractor) a <br /> - <br /> ZONING ADMINISTRATOR ^r-c ���� _— F i g <br /> MFA 4 H° <br /> TOWNSHIP PERMITS MAY BE REQUIRED N o <br /> i fpl� pN tpJ� pN pO pO <br />