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6-0 Cnw <br /> Burnett County 741QCo. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m - 0 <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 2 w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m ; h <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> 0 <br /> regulations of the St a of Wisconsin. w <br /> 1 p rn � f d tv% n C OE <br /> OWNER (Please,er�nt) Contractor or Surveyor or Agent m ` m <br /> (9 y 41 <br /> Ad rs. Address <br /> e4- -&�A {yl N SS00 / (� <br /> City, State,Zip Code City, State,Zip Code $� <br /> I S <br /> 1.0 1 —N ZI 34-, -7D5 Telephone <br /> elephone <br /> ag:) ( - <br /> Emergency/Fire No. and Road Name <br /> Q <br /> Legal Description (as Indicated on tax statement) 91 <br /> �_ L7 <br /> 0 <br /> Permito <br /> Permit(s) Applied for: y <br /> r <br /> O <br /> Dwelling Addition Filling/Grading Camping Unit � <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision c _ <br /> Garage _- / j <br /> Structure Use: '"'r /y L[� �� �' <br /> (family home/cabin, garage,addition, etc.) r� <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). O o <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). c v <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)buildingZ `c <br /> measurement to the ordinary high water mark of lake,stream, or river. P (� a 10 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m p o R <br /> dated by the owner. <br /> PLOT PLAN m <br /> ( �m <br /> oo ` <br /> 0 <br /> c� <br /> N <br /> O <br /> O <br /> S IWVQ <br /> Z <br /> 9 <br /> rl <br /> is <br /> 0w �DaVm <br /> m o. N } W M <br /> O J m <br /> Z <br /> c A O <br /> s �8 <br /> G - m m <br /> N' O j C <br /> c <br /> � [ AA. x <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know) ` 4 : 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- <br /> edge " m N O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 8 m g . <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 <br /> 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 m g m <br /> access to the above described premises at any re nable ti for the purpose of inspection. ; : A N i <br /> N � <br /> SIGN HERE <br /> (signature of ow r or building contractor) (date) o s : <br /> 8 € <br /> ZONING ADMINISTRATOR <br /> X 0008' m <br /> TOWNSHIP PERMITS MAY BE REQUIRED 88 g L9999M0 <br />