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xoe <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratord 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and H <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the N <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. <br /> R _vt�j A , K )r_ <br /> OWNER (Please Print) Con actor or Surve�Yor or Agent o <br /> 'ctC I�fl-NSC_o� bIZ1> KOt`h� m <br /> Address Address t <br /> D rbu rig , �I SSI �3 o St Vit_, LR KFS I w t <br /> City, State, Zip od Cry, State,Zip Code <br /> rl) s - a SG!- ,SkS ?��- asci -3?04 <br /> Telephone Telephone <br /> 'aGagq I�AtJ owe LftKF_ RU <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as Indicated on tax statement) <br /> n L7 <br /> 0 <br /> Permit(s) Applied for: 0 <br /> Dwelling Addition Filling/Grading Camping Unit B °^ <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision o m <br /> Garage <br /> Structure Use: <br /> 0 <br /> (family home/cabin, garage, addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). 4- <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). C 3 DQ <br /> 3. Show the location of any lake or flowage-if within 1000 ft. and the location of any river or stream- if within <br /> 300 ft. o a <br /> 4. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building ` H' <br /> to lake, river or stream, if applicable. M on <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and H <br /> dated by the owner. 9 <br /> m <br /> PLOT PLAN <br /> I <br /> C%h2o� o <br /> C 7 <br /> U) <br /> o <br /> y <br /> I" <br /> 73 <br /> z <br /> I <br /> 9 N W vcnr DD * U <br /> Ili I,! AUG 2 <br /> LJ U oD mZ,;!N00 NO IM <br /> 3 <br /> OO : "r <br /> f7 TN: <br /> m <br /> 8 € <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m n m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. <br /> N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g g <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. <br /> N : 9 A e <br /> SIGN HERE n <br /> (signature of owner or building contractor) (date) o Fr <br /> ZONING ADMINISTRATOR � A)'6f'I"N 8 <br /> w <br /> NN O N 8 m <br /> TOWNSHIP PERMITS MAY BE REQUIRED u, u, u, u, 8 0 8 0 15 m <br /> (Mn <br />