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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; o ' o <br /> APPLICATION FOR — LAND USE — PERMITS3. 0 <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and N <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 3 n <br /> regulations of the State of Wisconsin. - ,.. <br /> w d <br /> fw <br /> M £ <br /> OWNER (Ple se Print) Contractor o?Surveyo,orAgent <br /> ! 92 �eyttr <br /> Addrer@ =t2e Addreyb0 <br /> City, Spate,Zip Code City,State, Zip Code <br /> Telephone Telephone <br /> R'7y/ -(j, B ss Lk j <br /> Emergqncy Fire No. and Road Na e <br /> Lo l0 ('Sm U ) T (ry��-3aa , _4 74AN <br /> Legal Description (as Indicated ax statement) o <br /> Permit(s)Applied for: <br /> Dwelling Addition y Filling/Grading Camping Unit o Z <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision ° m <br /> Garage <br /> Structure Use: Z Y/ L5 Se*'0 r w foveL <br /> (family home/cabin, garage,addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) G <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). O <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 0 3 <br /> 3 .Show dimensions in feet of thefollowing:(a)building to all lot lines,(b)buildingto center line of road,(c)building 0111 <br /> z cv <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 n <br /> dated by the owner. M 0 <br /> PLOT PLAN m <br /> i <br /> I <br /> m <br /> 0 <br /> D F 0 �I <br /> 0 <br /> a0ya-I <br /> Sr m <br /> aOEB c3 E13 I <br /> 0x <br /> � /}Q01G ISN <br /> 3 ,{ Idxl4 <br /> s <br /> — i p <br /> Non ocm Q <� oNimcD, a £ m <br /> .�..-..+..... . ?)4 a 6 N d C <br /> ..n. .a,..... c < ` H o 5 0 3 <br /> Zom ,z 1 <br /> 0 <br /> c � m <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of m knowl. �'`'g `� m <br /> DP 9 Y ) Y Y o . <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs. (n m O <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. 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 <br /> access to the above described prem'se t any reasonable time for the purpose of inspection. m g <br /> W o A w <br /> SIGN HERE <br /> igna on�building contractor) (date) <br /> ZONING ADMINISTRATOR g <br /> N , <br /> TOWNSHIP P RMITS MAY BE REOUIRED °LY vN N o o m <br /> y <br /> � 88888 $ 88 <br />