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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m -- 0 <br /> APPLICATION FOR - LAND USE - PERMITS3, <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 5 <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 f Wisconsin. <br /> POhC% /� C JJ 10�✓ <br /> OWNER(Please Pri Contractor or Surveyor or Agent o <br /> 176 �L VetL� <br /> Address `,� (� Address <br /> r!'�rJ <br /> City, State, Zip Code ^ City, State,Zip Code Q <br /> Telephone 6Z-! 1-1Ss- a / Telephone <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as indicated on tax statement) <br /> n L) <br /> Permit(s) Applied for: 0 c <br /> Dwelling Aciddion Filling/Grading Camping Unit o <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision ° <br /> Garage <br /> Structure Use: ,DAN t t I / U r <br /> ' o <br /> (family h e/cabin, garage, addition, etc.) 1 <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). 0 v, <br /> 3. Show dimensions infeet of thefollowing:(a) building to all lot lines,(b)building to center line of road,(c)building . Z it <br /> measurement to the ordinary high water mark of lake,stream,or river. o o <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m n' <br /> dated by the owner. C 0 <br /> PLOT PLAN m 1 <br /> 1 <br /> AMA O"n <br /> I � <br /> n_ <br /> o <br /> O a <br /> = v� <br /> �r1L_J <br /> I� <br /> Z <br /> I 31 <br /> l I 1 <br /> M0 c 2 m m o n F -,a <br /> m. pad maN . 9 <br /> ^ < Q m o 3 5 $ <br /> zea ; `n � <br /> f a <br /> Tn - m <br /> a : m C <br /> 8 € M <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- S m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy ofall informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 75 ro uNi <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I i i g m 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 g m <br /> m A m <br /> m m <br /> SIGN HERE /� _ ~ �N 0 <br /> (signature of r or building contract <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS M BE REOUIRE� '' MAY 2 2 I e o o m <br /> 'i li 888vmi <br />