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Burnett Pounty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d A o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and i S� <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 W�isgonsin. m m <br /> Hams . Ve nr-eq � 1endo �SeI F ) m o <br /> OWNEPlease intCo racln�eyororAgent o <br /> 1 <br /> Addr s ` � Address � <br /> f7C70� t t( ` i S con s.,Y1 <br /> City,St e,Zip Code I City, State,Zip Code <br /> EY f?01 <br /> Telephone Telephone <br /> lis— ZIA ff'— 73 0 <br /> Emergency/Fire No. and Road Name <br /> a!j74 ­4 Pop up -Foam Datgq <br /> Legal Description (as Indicated on fax statement) o <br /> aocTJ <br /> Permit(s)Applied for: Repiy- PO <br /> r w r <br /> Dwelling Addition Filling/Grading Camping Unit o °- <br /> v <br /> Z a <br /> Accessory Building Sanitary Privy Subdivision ° <br /> Garage 3 <br /> Structure Use: _ a6a �at7l�I I(GYI 1 <br /> (family home abin, garage, addition,etc.) ° <br /> '11 W <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). 0 <br /> 2. Show the location of the well ° <br /> (W),septic tank (ST), and dralnfleld (DF). 3 <br /> 3. Showdimensions Infest of thefollowing:(a)buildingto all lot lines,(b)building to center line of road,(c)building � Z c <br /> measurement to the ordinary high water mark of lake,stream,or river. o a <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and w <br /> dated by the owner. m o <br /> / / C J <br /> PLOT PLAN S/� q6 Xa ClaSe/ >`d M O <br /> ZaBe <br /> � a��wa CCCMSS AO <br /> S �, Gl�aaPs o T <br /> � N <br /> / A 1 <br /> rl?=> F— dye--� QC ./Ls o• O � <br /> O <br /> N <br /> ➢kR � ��L�„M � <br /> C <br /> z <br /> 3,r a <br /> {,t�J�� LD. <br /> o c m m o a F M <br /> aC// . o Z a a oo a = C <br /> V = <br />