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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m' 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v w R <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the N m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. m <br /> �E1yN/S ul, ScNM/IST a f <br /> OWNER (Please Pr'nt Contractor or Surveyor or Agent o <br /> 5.9 � U�NC'A sT�Y � � <br /> A�0/A)A AIA) <br /> S Sg3� Address <br /> Ci State, Ip Code City,State,Zip Code <br /> M.2-� 220'.34:1' Z <br /> TTMaphonT Telephone <br /> ,�S70 /2NSK f/i�L ,�'1J, <br /> Emergency/ Ire No. and Road Name <br /> Z-or Yf Vo—a, v . Pf 14-3 d&*,f /a{ -/�uP37 Al, E 1¢ t.k) <br /> Legal Des riC ption (as Indicated on tax statemen <br /> Sc_2E iN O�4c 0 <br /> Permit(s) Applied for: ,-� eNTk y o °- <br /> Dwelling Addition f' Filling/Grading Camping Unit S <br /> v <br /> z o <br /> Accessory Building Sanitary Privy Subdivision ° $ <br /> Garage <br /> Structure Use: &,31A) 5 <br /> (family home/cabin,garage,addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). c <br /> O <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). D3 V)3. Show dimensions Infest of the following:(a)building to all lot lines,(b)building to center line of road,(c)building 11 aZ `c <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 p y <br /> dated by the owner. ^� C 7J <br /> PLOT PLAN l A m <br /> 0 <br /> Q <br /> pepe <br /> �N rT d <br /> / G x l 5T! o <br /> / ' , <br /> I'7 <br /> Df „.^D <br /> M o c m m a T <br /> o- m j <br /> Lucio .0m 3 <br /> N <br /> DtAO t3�D �/� P f T fn: 7 <br /> K-UfjjJ U <br /> m g : C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- S : r <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- a C <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 <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 'a' <br /> access to the above ibetl premises at any reasonable time for the purpose of inspection. ro $ � <br /> 3 A I <br /> SIGN HERE O isZ—! N N <br /> (signature of owner or building act idat o x <br /> ZONING ADMINISTRATOR g <br /> TOWNSHIP PER ITS MAY BE REQUIRED <br /> 8 ` °88 <br />