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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rn -a i z <br /> APPLICATION FOR - LAND USE - PERMITS �_ E <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 n <br /> regulations of the State of Wisconsin. — o <br /> UtD �. m m <br /> m <br /> ���t=4 c <br /> n O <br /> OWNER (Please Print) Contractor or Surveyor or Agent o <br /> _�1d15 t i;1 Lpmy NE m <br /> A 'AIA yy�� �J54� Address `� 01 <br /> 47 tt1 I <br /> C[y State, Ztp Code City,State,Zip Code <br /> lo12-1S5 <br /> TelephoneG f r 77 Telephone ' J <br /> rµ` <br /> VLow <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as Indicated on tax statement) <br /> Permit(s)Applied for: Pic yd,�o. /3S' Gedleyo hos 51 � o <br /> 0 < <br /> Dwelling Addition Filling/Grading Camping Unit o <br /> Z <br /> Accessory Building Sanitary Privy <br /> Subdivision <br /> Garage m <br /> a <br /> Structure Use: PrGE SHED <br /> (family home/cabin, garage,addition, etc.) rT <br /> 1A , <br /> DIRECTIONS FOR PLOT PLAN DRAWING: Q V <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). 9 <br /> 2. Show the location of the well (W),septic tank (ST),and drainfleld (DF). 0 <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 v <br /> ft. � Z `v <br /> 4. Show dimensions in feet of the following:(a)building toall lot lines,(b)building tocenter line ofroad,(c)building n S. <br /> S. <br /> to lake, river or stream,If applicable. m c <br /> S. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C <br /> dated by the owner. <br /> M Q)i <br /> PLOT PLAN I D <br /> E5 = IbX3o' <br /> NB= 12X 12' � <br /> W = None i U <br /> ST 4 NonE <br /> 0 <br /> _ <br /> o <br /> _ <br /> y O y <br /> gym. <br /> o = I <br /> 2 w <br /> A=94't z <br /> s <br /> C= 33'2 <br /> o rRl�OD 0 40't <br /> %Ab <br /> °ii �� � R n � m <br /> a m� � a � ama <br /> P <br /> q ,�oC0 o � C 0 3 1 <br /> M <br /> S` Ellrn.1 WEIt —RPr'Hex /.50�t L-,e <br /> g n c ? C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- [ g ? m m : E a <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- O ' m <br /> yy�ma[ O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I .8 m g <br /> further accept `I' bility which may be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication.I ag a to"mit county officials harged with administering county ordinances or other authorized person to have <br /> access to the ove escrib r mises at any reasonable time for the purpose of Inspection. . O"'o' <br /> 3 8 0 <br /> m i A x ; <br /> SIGN HERE m e m <br /> (si ur of o n Ilding contractor <br /> ZONING ADMINISTRATOR �'-`— <br /> TOWNSHIP PE MITS MAY BE REQUIRED MAY P ��91 Zno o m <br /> NO s 8 s s 8 s y <br />