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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54072 Office of Zoning Administrator d W c o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <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 /> 0 <br /> regulations of the State of Wisconsin. (��� a �►ct},yc,� w m <br /> 1 A <br /> Barbara 7 (Z enne.( T a ° <br /> OWNER se m Contractor or Su=Agew 7rh 5T m�(Plea , m <br /> Flo . , aPrint) 5+ . <br /> A dress Address <br /> AS+Ings M(iJ , 55633 Ns7,*gs .11Y' SSvs3 <br /> City, State,ZiF)'CodA City,State, <br /> Ola - '43 -7 95"ai vip 6'/ <br /> [L - w C7- <br /> Telephone nr r Telephone <br /> octol <br /> EmeNency/Fire No. and Road Name <br /> -5jZZzYja�L2 w 461 # yu. 49, iy 6a160 VV1 2 sda sNov <br /> Legal description (as indi sled on tax statement) -7ec /iE N <br /> �G /fcrr5 <br /> o <br /> Permit(s)Applied for: <br /> m � <br /> Dwelling Addition X-1 Filling/Grading Camping Unit S <br /> v <br /> z o <br /> Accessory Building Sanitary Privy Subdivision <br /> GarageTT <br /> Structure Use: `-ry/�r'/V "Z,/ron., <br /> (family home/cabin,garage, addition, etc.) T- <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) M I rn <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). o <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 3 <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 v <br /> measurement to the ordinary high water mark of lake,stream,or river. c o, <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and l7 N <br /> dated by the owner. m ° <br /> C ' <br /> PLOT PLAN <br /> C' <br /> G 0 Se JI i C n <br /> o v` <br /> Well <br /> r Ci6� GB � f�.✓5 a mom. � � <br /> d � ' >< a y <br /> Q 3 01A�- <br /> ,/do-'l C66t a <br /> 3� <br /> 1 <br /> ,Jo GA IWO. r'o <br /> � p aY l a Sf� Scs✓ ave � <br /> 3 m Mz oart nWa <br /> 9 <br /> A Z ' Z m O F m 3 <br /> Z N m .z 1 <br /> / o � c ' ! m <br /> cc <br /> c <br /> Er <br /> �0 : € <br /> I declare that this application(including any accompanying schedule)has been. mined by me and to the best of my knowl- m <br /> S . ;2m <br /> edge and belief it is true,correct and complete.I acknowledge that I am respons a for the detail and accuracy of all informs- w m N O <br /> v <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- m N . <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 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 n o <br /> access to the above described premises at any reasonable time for the purpose of inspection. ' m 8 0 <br /> {� A w f <br /> 8s <br /> SIGN HERE d te) <br /> (signature of owner or building cont ct ( <br /> 8 <br /> ZONING ADMINISTRATOR <br /> �:9998888 <br /> TOWNSHIP PERMITS AY BE REOUIREDw <br />