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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator da o <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 5R „ ty <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. m m 7 <br /> N � <br /> Voyager Village POA Northland Builders, Inc. o O <br /> f <br /> OWNER (Please Print) Contractor or Surveyor or Agent <br /> m <br /> Address 28551 Kilkare Road Address <br /> Danbury, Wi. 54830 4155 Redwing Terrace C <br /> City, State, Zip Code City,State,Zip Code <br /> Danbury, Wi, 54830 <br /> Telephone Telephone <br /> 715-259-3910 71 -2 - 2 7 <br /> Z-- <br /> Eme <br /> Legal Description (as indicated on tax statement) T o <br /> o <br /> Permit(s) Applied for: 0 �. <br /> N � <br /> r <br /> Dwelling Addition Filling/Grading Camping Unit o <br /> z o <br /> Accessory Building — Sanitary Privy Subdivision ° Poi <br /> Garage (J <br /> Structure Use: /y�yy�� �`'l��'I /5� � <br /> (family home/cabin, age, addition, c.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: G <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). 0 3 <br /> 3. Show the location of any lake or flowage- if within 1000 ft. and the location of any river or stream- if within 11 v <br /> 300 ft. o a <br /> 4. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building mu, <br /> to lake, river or stream, if applicable. �, 0 <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. (A <br /> M <br /> PLOT PLAN <br /> I <br /> n <br /> �1 <br /> � <br /> j� Yfi' C�� o <br /> 0 <br /> ri I� <br /> o � <br /> N_ <br /> z <br /> I-D^ <br /> u <br /> m o N . m m o a F m <br /> m > > n <br /> 3o-m � T. 9 <br /> o mo o 3 3 <br /> n <br /> z <br /> P TNIC: i m <br /> ut i G) E O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- U,) <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this info ro <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 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 <br /> _ <br /> SIGN HERX V n <br /> (signal re of own building contractor) (date) o x <br /> ZONING ADMINISTRATOR/,'M <br /> d1 d1 HMe1W -n <br /> TOWNSHIP PERMITS MAY BE REQUIRED N o o S m <br /> 88 $ 888ai <br />