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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator c m -- 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> 70 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 <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. N m f n <br /> //1S �5nind 1f' 6raut� a � o t <br /> OWNER It)(PleasePri Contracoro Surve o or Agent o O mJ <br /> m <br /> Address dtl ens 1 I <br /> City, State,Zip Code state, Zi Coe <br /> Telepho e /� ^ Telephone <br /> (07/(001-V 1111 <br /> Emerge y/Fire N . nd R Name f <br /> Ila i <br /> Legal escripti (as indicated on tax statement) k-t / es/r) V (7 )o a <br /> Permit(s)Applied for: `-'- o <br /> o `. <br /> J » <br /> m � <br /> Dwelling Addition Filling/Grading Camping Unit o ° <br /> Accessory Building z (� <br /> o a° <br /> Sanitary Privy Subdivision m <br /> Garage <br /> Structure Use: I 1 nf()e - am ID6*cClY) �4toh/wk <br /> (family home/cabin, garage, addition, etc.) ° <br /> DIRECTIONS FOR PLOT PLAN DRAWING: O <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). M <br /> 2. Show the location of the well (W),septic tank (ST),and dralnfield (DF). G 3 <br /> 3. Show the location of any lake or flowage-If within 1000 ft. and the location of any river or stream- if within an ? m <br /> 300 ft. <br /> 4. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building <_ <br /> to lake, river or stream, if applicable. III Zjo <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C J <br /> dated by the owner. 0 . <br /> PLOT PLAN L01 l,) �� afo <br /> " FRer�1 Ary 1 I <br /> >ti ADD. <br /> 3 Wily o <br /> rR k-oG , <br /> m <br /> o <br /> w <br /> 2y 72L-0PAR G6 <br /> 52 30 <br /> f <br /> 0 <br /> m. aa`* > Em ° as <br /> V //n,.� O O O m _m <br /> sal ren;r J a3/G J�� ( �(� l F J c c T <br /> /��- <br /> m <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of m knowl- g ' iD �^ M <br /> PP ( 9 Y ) Y Y o E <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 yy!!m p <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- tg m - <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 66 8 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 <br /> access to the above described premises at any reasonable time for the purpose of Inspection. m ut m <br /> r 3 A <br /> � <br /> SIGN HER (siu f owns ding'c�ontractor) (date) SZONING ADMINISTRATOR WNSHIP o <br /> Ww axAg <br /> m <br /> PERMITS MAY BE REQUIRED <br /> 88888 $ 88y <br />