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bt�_ce , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ( 3 -- Z <br /> APPLICATION FOR — LAND USE — PERMITS o d <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 3 a t>1 <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ X/ <br /> 0 <br /> regulations of the State of Wisconsin. y <br /> WILLIAM m CALTj . LEI: �Ct t a ° <br /> OWNER (Please Print) Contractor or Surveyor or Agent w �� <br /> 4)6 I Flekfy8EArh �2• V Z <br /> Address Address <br /> Rit.KvILLL- L^ml 1.0813 <br /> City, State,Zip Code City, State,Zip Code <br /> j0J- Q­ii.R- 3DfI (w) 3til-yrl-�y33 W <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name <br /> 3os-il. VnkiLVfro LAIV <br /> Legal Description (as Indicated on tax statement) o <br /> 0 o <br /> o` �- <br /> Permit(s) Applied for: N <br /> Dwelling Addition Filling/Grading Camping Unit P <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision g <br /> tiara e <br /> Structure Use: �A2r lr i! '_I 0 <br /> (family home/cabin,garage, addition, etc.) <br /> 0 <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). O o <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). �3 <br /> Cn <br /> 3. Show the location of any lake or flowage- if within 1000 ft. and the location of any river or stream- if within on Z Q <br /> 300 ft. o o. <br /> 4. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building m `\; T <br /> to lake, river or stream, if applicable. y�✓Ut <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C <br /> dated by the owner. m R a <br /> PLOT PLAN <br /> to <br /> 1 <br /> LVY ).4 7wO CflQ CARAir -SFE PLOT PLAA <br /> AT7At 140 s <br /> -c <br /> 0 <br /> r► � 569 <br /> N <br /> O <br /> 1 Z <br /> C11 r0afoc � aom <br /> CD. 9a.`L ='aN afD M <br /> m <br /> o f s T,2 ' M <br /> =' m <br /> LA C <br /> $ ac : <br /> m <br /> o <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- mG) <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- Fn m O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- $(0 N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ $ <br /> further accept all liability which may be a resu f the County of Burnett relying on this information I am providing in this ap- in <br /> N <br /> plication. I agree to permit county officials chaN.6qwith administering county ordinances or other authorized person to have <br /> OPO ' <br /> access to the above described premises at any r nable time for the purpose of inspection. 91 8 N <br /> N N A <br /> y <br /> w� �1? N $ <br /> SIGN HERE <br /> ( ig ature of w er or building contractor) (date) o <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP/ ERMITS MAY BE REQUIRED f ro 0 N o o m <br /> $ 88888$ 8m <br />