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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m a 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> m o <br /> TO THE ZANING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 2c <br /> located as shown herein. The undersigned agrees that all work shall be clone in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance,Sanitation ode, and with all other applicable County Ordinances and the laws and <br /> re lations of the State of Wis onsin. w et V� <br /> Allfoeil :E <br /> OER ( ease t Contractor or Surveyor or AgentIn � <br /> o <br /> if' + m' <br /> AM ,r�r, / �`� `� Address / <br /> AT <br /> City, State, Zip Code /„/V J S City, State,Zip Code �W <br /> Telephone — Telephone } <br /> � 1 <br /> Emergency/Fir and Road Nam <br /> Legal Description (as in icated on ax erl / Q`� <br /> 0 <br /> Permit(s) A plied for: <br /> awe in Addition Filling/Grading Camping Unit S <br /> v <br /> 2 0 <br /> Accessory Building Sanitary Privy Subdivision o } <br /> Garage <br /> Structure Use: �� <br /> (family horn /cab(n arage, addition, etc.) <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). 0 0 <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (Il c n <br /> 3. Show dimensions Infest ofthefollowing:(a)buildingto all lot lines,(b)bulldingto center line of road,(c)building Z 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 5. <br /> dated by the owner. C V1 0 <br /> / a nU <br /> PLOT PLAN �T �;�1"iYe-�aA Af45f-/!)ee7Ldrr�lAdpee M <br /> -S'lr<hc�4/C�S JGJi�i/I f •' � 7 <br /> ao'tuid t�eirpnce.�/3 Ak+f i <br /> C/ea cza C7 <br /> 673_ 4 <br /> co <br /> n <br /> ll <br /> -.. -.._ <br /> N <br /> 7” _//� aN <br /> F 00 3 00 <br /> —7lL 61 <br /> kap � 2 . TN: <br /> $ i a = c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my for a- 3 m m <br /> edge and belief it is true,correct and complete.I 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 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 $ <br /> further accept all liability may be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication.I agree to pe, t unty officia charged with admini ering county ordinances or other authorized person to have <br /> access to the above ib�tl premis t ny really able t' to the purpose of inspection. m $ m . <br /> m 3 m <br /> A H <br /> SIGN HERE =r <br /> (signs re owner or 4ljAdhj contra <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS AY BE REQUIRE N N C m <br /> I,t � MAR 251992 ssssss U) <br />