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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d �, --I 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 U m <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 /> regulations of the State of Wisconsin. m d <br /> m <br /> _Sk'eIr). j C l7 CRS a o <br /> OWNER (Please ri L �� ontraa or Surveyor orAgem 'moo <br /> y.2 tl rn„ l�ry Cd n 4k e <br /> Address _ Address <br /> IA -tPLc-kQf- W <br /> City,State,Zip Coe City, State, Zip Code <br /> $(o(G 1-47 <br /> Telephone —� Telephone <br /> y.z ✓)\Qllctrr-L Lk. Pak , - <br /> Emergency/Fire No. and Road NameT <br /> Se '3V 5r0/V R1 SrJ <br /> S GSM I . S Ing C <br /> Legal Description (as Indicated on tax statement) <br /> 0 <br /> Permit(s) Applied for: o °. C <br /> = n <br /> o T <br /> Dwelling Addition Filling/Grading Camping Unit 0 <br /> v <br /> z o <br /> Accessory Building Sanitary Privy Subdivision ° $ <br /> Garage <br /> Structure Use: o n y Ra:�.-'A ' Z r <br /> 0 <br /> (fahilly home/c in, garage,addition, etc.) <br /> I ,,11 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 11� <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST), and dralnfield (DF). 3 <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building Z `o <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 H <br /> dated by the owner. M R-) <br /> PLOT PLAN 41111 <br /> 14 m 9 n <br /> Ch <br /> ea . <br /> Sp ► c — V <br /> LIU <br /> r <br /> f/o�� o47Q�. <br /> ell <br /> r <br /> Z <br /> �Ur t- <br /> �00 <br /> A o a ? a F m <br /> a : Z <br /> o. <br /> z0 ' = ro3 <br /> - o f 0 <br /> : : m <br /> 8 : a <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl g [ 0MG 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- v+ m N . O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 8 m ut <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 8 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 a �, <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have ut <br /> access to the above ribed premises at any reasonable time for the purpose of inspection. m 3 8 . <br /> A w <br /> SIGN HERE <br /> J' [ a <br /> (si otowne�or bui contractor) (d lel C o x <br /> ZOI G ADMINISTRATO <br /> TOWNSHIP/PERMITS MAY BE REOUIRED SP U S o o 8 m <br /> �:88998999 Mm <br />