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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 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 y <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 �_ a <br /> regulations`of the State of Wisconsin. <br /> ` �VFL---- -V LAM <br /> N�.1�"(�- f`r 11� <br /> ---j sc <br /> v o <br /> f <br /> OER (Please Print) Contractor or Surveyor or Agent o <br /> 2-ER <br /> 6A Al <br /> Address,VIA" <br /> 2:4M. M/\j tJ5,3'f' Address <br /> City, State, Zip Codee7 City, State, Zip Code <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Nama U"Lf V/ Pr1V� <br /> Legal Description (as�ifpdicated on tax statement) 1 <br /> 71-srr"q`7 <br /> Permit(s)Applied for: /P_ib (n/ 0 <br /> m r <br /> Dwelling Addition Filling/Grading Camping Unit <br /> v <br /> Z o <br /> Accessory Building ly-L— Sanitary Privy Subdivision ° <br /> Garage F� p <br /> Structure Use: o <br /> (family home/cabin, garage, addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: 0 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). A O <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 an <br /> p <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 m �I <br /> to lake, river or stream, if applicable. <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C �l <br /> dated by the owner. 0-- d0 � —� m <br /> C' <br /> Z <br /> PLOT PLAN Ll u- "&J 6i V ' <br /> CI IF1 <br /> I <br /> cc <br /> Q o <br /> X <br /> m <br /> fe <br /> Pe&m4 Ali b .v/ = L� <br /> r 0V er N <br /> 7) <br /> mfrrk aVF <br /> �j <br /> a <br /> S-, �o <br /> DF <br /> o c m m 9 <br /> lof' <br /> '20 <br /> Dnp anm am M <br /> : Z m o n <br /> o m1 <br /> Gam - _ _ � ; : M <br /> L-�11C� m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- . b m `� m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- f 0 <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 8 8 <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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 8 d <br /> ^ N <br /> m m a <br /> SIGN HERE <br /> (si at re o o r or building contractor) �. - <br /> ZONING AD IN STRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED MAR 2 9 N N N N No o 8 m <br /> 8888888rmn <br />