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Burnett C-aunty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U) - -01 OZ <br /> APPLICATION FOR — LAND USE — PERMITS 3, <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 0. <br /> regulations of the State of Wisconsin. / _ / m m <br /> ,inI 1R`ln VIAV , oC � !/e /Y1.7—irv/A n F <br /> OWNER Pleese Print) Co actor or Surveyor or Agent m <br /> 1 <br /> Addte4s Address <br /> o .rr� <br /> c ty, �te,Z' cod city, st p code <br /> Teleph6ne Telephoft <br /> Emergency/Fire No. and Road Name <br /> parpol <br /> egal Description (as Indicated on tax statement)/�� aF a-rrc:rdcd opl- o <br /> \l ci <br /> 0 <br /> Permit(s)Applied for: c. <br /> m r <br /> Dwelling Addition Filling/Grading Camping Unit ° g <br /> v <br /> Z a <br /> Accessory Building sanitary Privy Subdivision ° } <br /> Garage <br /> / CC <br /> Structure use Z + �`% Sg L'� S? r✓v r.l� �` r <br /> l� <br /> (family homelcabin, garage, e4dition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NS) and Indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST),and dralnfield (DF). 3 m <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building z <br /> measurement to the ordinary high water mark of lake,stream,or river. P n <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and o <br /> dated by the owner. C 0S <br /> PLOT PLAN <br /> rct <br /> y <br /> m <br /> 0 <br /> sus, 0 <br /> ✓' Q 1� 7K <br /> � D <br /> f <br /> Gyp <br /> w Pry /s x o c , m 0 o a E m <br /> -7 eCt�P� A =Kano zma <br /> 01 41n z < a--: 1 m 1 <br /> 0. <br /> 8 <br /> fill <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o 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- yy!�m a <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this infor- `: 25 0 N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue <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 perm' co officials charged with administering county ordinances or other authorized person to have n ut 0 : <br /> access to the above de iD pr mixes at any reasonable ti a for the purpose of inspection. m $m <br /> 3 <br /> m n <br /> B 8 ^ x : <br /> N <br /> N N <br /> SIGN HERE <br /> (signature owner or I g co tractor) l e) 5 o z <br /> $ <br /> ZONING ADMINISTRATOR TOWNSHIP PERMITS MAY BE REOUIRED Ftp <br /> Ctro 21 m" <br /> $ $ $ $$ $ $ <br />