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Burnett County 7410 Co. Rd. K, No. 102, Siren, Wi 54872 Office of Zoning Administratorw 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> 0 <br /> TO 1 HE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 'z y <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 3 <br /> re ulations of the Stat of Wisc sin. y C <br /> RiAnl �. Me1)UAI ko, PARD ufJ a G o <br /> OWNER (Please Print) ontractor rSurve ororA t +f' o <br /> S?C ` A Hwy 97 <br /> AddressAddrs <br /> s <br /> N, E. � 3Urcy W, 5. sysso <br /> City, State, 0Cocle /I? SJ`�� 8 City,State,Zip Code <br /> All y <br /> TelephoneTelepho��p _ 3O <br /> u L- <br /> / •- 6 /R — 781 - <br /> Emergency/Fire No. and Road Name _lou y �'77 <br /> Legal Description (as Indicated on tax statement) JO' <br /> c) <br /> Permit(s) Applied for: 0 C. <br /> m 0 <br /> Dwelling Addition Filling/Grading Camping Unit S <br /> OQr v <br /> I' z o <br /> Accessory Building Sanitary X Privy )< Subdivision ° <br /> Garage <br /> Structure Use: Q A8/N r <br /> (family home/cabin, garage, addition, etc.) 0 <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). M 0 f <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). C 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 P <br /> 300 ft. Z ) <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 <br /> to lake, river or stream, if applicable. <br /> S. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C I <br /> dated by the owner. m <br /> PLOT PLAN rJ o.t T H y <br /> Ce it r/ !%/,5://A- I <br /> l /u ryr�ih C�/�P ctrl <br /> �wE ))17 <br /> !�� r dY 9�PLd m <br /> PERS <br /> +ESt <br /> 0 <br /> PizP Y <br /> rte �t��� <br /> o f G Pe 0 _ <br /> SC +I c- (;yC/ E A5 T <br /> WEST � a� <br /> p c�s <br /> /©v <br /> Z <br /> z <br /> 53 ' DR(YE- ti'l <br /> o?o l�c,ees, <br /> 6a , — F� VV 9 <br /> .¢ //� /► o o c oNi w D a F Irl <br /> / V �' Dai ' C am <br /> /SlWy - mz cHo � 3 <br /> oo <br /> _ m m <br /> SO UT o <br /> S <br /> dam : c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- S `� a <br /> 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- `n m.n : O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- $ W rN <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 m g <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 escribed premis at any reasonable time for the purpose of inspection. m 8 m <br /> m i g n <br /> m a A m i <br /> Q m m <br /> SIGN HERE /157 40 H n N g <br /> n : <br /> (signature of <br /> owner or b ilding contractor) 1 (date) o s <br /> ZONING ADMINISTRATOR <br /> fn w rw w <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N n N O O <br /> 8 8 $ $ $ 8 <br />