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Bumett-County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U) s o 0 <br /> APPLICATION FOR - LAND USE - PERMITS ' ' <br /> m <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 $ <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. r w m <br /> tN?g2X -�- C -kwS F(toe.�A�.t V ) f <br /> OWNER(PleasOPrinty Contractor or Surveyor or Agent m <br /> aaLoto <br /> Address Address i p <br /> ,M <br /> City,State,Zip Code City,State,Zip Code <br /> Telepho �� Telephone <br /> cu <br /> EmergencyTrNo. and Road Nettie <br /> —� <br /> Legal Description (as Indicated on tax statement) <br /> n O <br /> 0 <br /> Permit(s)Applied for: 0 - <br /> Dwelling Addition X Filling/Grading Camping Unit <br /> v <br /> z o <br /> Accessory Building Sanitary Privy Subdivision ° <br /> Garage <br /> Structure Use: CNtB\M — \ o0.c� Aaa��oW c <br /> (family home/cabin, garage,addition,etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) A <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 drainfleid (DF). 3 m <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building .A - c <br /> measurement to the ordinary high water mark of lake,stream,or river. o <br /> 4. B 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 <br /> C <br /> PLOT PLAN 0 <br /> I <br /> R <br /> 0 <br /> o c �j <br /> m <br /> C <br /> � z <br /> l D <br /> o c m m o n m <br /> D w a w <br /> a = a <br /> $ 0 a 3 3 <br /> Z o ZQ 't <br /> cc'€ i In <br /> 1 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 informa- '� : E H O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ro i7 <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ 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 O iX <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> B � Au <br /> s <br /> SIGN HERE <br /> (sign or uildtn r ' MOAtb), <br /> o . ? <br /> iI E 8 <br /> ZONING ADMINISTRATOR - <br /> M <br /> TOWNSHIP PE ITS MAY BE REOUIRED JUL 511 o o m <br /> J 88888888rn <br /> - <br />