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Burnett County 110 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rn -p <br /> m £ o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <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 m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. H m <br /> OWNER Please( Prim Contractor or Surveyor or Agent o <br /> ,� 757 9 r�c��ieS m <br /> A rens Address g <br /> �vt�s frr 7 <br /> 3 <br /> City,State,Zip Code City, State, Zip Code <br /> Telephone Telephone <br /> Q1 <br /> Emergency/Fire No. and Road Name <br /> 9'91599 - >eries <br /> Legal Description (as Indicated on tax statement) o <br /> n O <br /> Permit(s)Applied for: 0 0 <br /> m r- <br /> Dwelling Addition Filling/Grading Camping Unit o ° <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision ° <br /> Garage A //� y� / <br /> Structure Use: E�OSC( f6" U"Uth PieLL) S1�P� j1j -t- Nhyj = <br /> (family home/cabin,garage,addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) C <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). 91 3 <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)buildingZ o <br /> measurement to the ordinary high water mark of lake,stream,or river. o a <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and O H <br /> dated by the owner. m 0 <br /> PLOT PLANM <br /> L0 <br /> 5-e' <br /> I <br /> o lye <br /> A{,QcClas a� F'Yr�r 11I'(>. <br /> o m <br /> /wt- to 6L c�CIL L/ PF 1,j W <br /> _/ a Z <br /> P J, .�. <br /> Wc ;? ro m $ a F m <br /> A. Dii'� aiiN a = a <br /> 2 m p i m .Z <br /> F = 2! U) 9 <br /> M <br /> Zn ' m 2t i C <br /> 8 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> M <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs. « m D <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue apermit. 1 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 u, <br /> access to the above described premises at any reasonable time for the purpose of inspection. m g <br /> m : <br /> m <br /> SIGN HERE <br /> gna re of owner ilding contractor) Id te) n <br /> P : ? : <br /> 8 <br /> ZONING ADMINISTRATOR <br /> «: <br /> TOWNSHIP PERMITS MAY BE REQUIRED "08 «� m <br /> Otto N O O O <br /> 88899999m11 <br />