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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. w d <br /> OWNER(PlIVrint) Contractor or Surveyor or Agent o A <br /> I OS At e� NE <br /> Address Address <br /> C650-0 , vvi n 553A <br /> City, State,Zip Code , City, State, Zip Code <br /> 6ta -47_4-3735' fra 114i- 7o!¢ <br /> Telephone \ Telephone <br /> tJ/A CR EAs>✓ Acs c ]k 1 1 AniK" m LAKE 'ra Ai tai A� <br /> Emergency/Fire No. and Road Na e�� <br /> SG, &- Ila 5 vi o 4W Ames .-rlo LL-t 40 <br /> Legal Description (as Indicated on tax state ent) k E{r ArLIL <br /> Lo-r-4GSM v 2 P35 (t,uv-tnt' 3C� P A v t( wA -6 M <br /> n c) <br /> Permit(s) Applied for: \\ j 'C <br /> N r <br /> Dwelling Addition Filling/Grading _ Camping Unit ° g <br /> v �! <br /> y Z o <br /> Accessory Building Sanitary Privy x Subdivision ° _ – <br /> Garage 3 o x 48 <br /> — fZL`_�U nTAt1L.S DW To L-A 11, <br /> Structure Use: a o <br /> (family home/cabin, garage, addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 9 Z- <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). c <br /> 2. Show the location of the well (N),septic tank (ST),and dralnfield (DF). � c v <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 o <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 m o <br /> dated by the owner. C l o <br /> PLOT PLAN 1 " D'Clcq , <br /> MAX YD'' tti� (1) <br /> e , <br /> r-0 LNKNo'NN lGf♦wNT'E /1tA 1-Ol.w6I VI) ( <br /> n <br /> o <br /> /� v) o <br /> J <br /> 0 <br /> 3 r, <br /> d y j <br /> � -o .11 Rte% <br /> w Iwl J <br /> 3 <br /> 2g 5.82' f = <br /> g / 2 7�) n <br /> A(?1 LIE a <br /> CCC , <br /> i `, <br /> c �in m > a -a <br /> ZfnrJ . rJI84.10re c - � '.mn2a- lt <br /> Z < o 'ZHo ° ' 3 <br /> .� m <br /> O % N . <br /> Y q m o, 3I <br /> Ll -YgO ° i O <br /> G <br /> r <br /> I declare that this applicatio including ani/accompanying schedule)has been examined by me and to the best of my knowl- I S ; m m <br /> edge 4pd belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- <br /> tion cdhtained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- E I; m N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 1 <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 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 an asonable time for the purpose of inspection. <br /> to <br /> SIGN HERE « ` a <br /> (sig ure Pf owner or building conlracto (date) <br /> o ? [ <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED JrI o o 15 m <br /> 98 <br /> 8 $ 8 $ � <br />