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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator � m o' a <br /> APPLICATION FOR — LAND USE — PERMITS � 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permd for the work described and � � ' <br /> locatgd as shown herein. The undersigned agrees that all work shall be done in accordance wdh the requirements of the �^ c <br /> Burnett County Land Use Ordinance, SanNation Code,and with all other applicable County Ordinances and the laws and 3 � <br /> regulations of the State of Wisconsin. � m <br /> _ �f /�/^/ A 1 <br /> OWNER(Please Pry',t) CoMr r Surveyor or Agent o m <br /> 5cgy- U CrAI.Lr �va�v �l% lz�?�/ /3aX297 W <br /> Address` Address <br /> W.�;.yi i2.e.¢/e � ,�-n inial ,s�i�d 7v � 1-� ���1 K h ,, a��s s 4 � F-/ <br /> City,State,Zip Code Ciry,State,Zip Code 1. � <br /> Telephone Telephone `� <br /> �0 ~/ /-� L <br /> Emergency/Fire No. and Road Name ^' <br /> Legal Description (as Indicated on tax statemem) � � <br /> +�(� s � at K .�`/� � Sec �-1 T 3 7 "'�a2 /d' /T/ ]`v um-T i��d L-'IC A JCt= � o RJ <br /> Permits)Applied for: ®�(� 3 CZ�p„p� � ^- � <br /> Dwelling � Addition Filling/Grading Camping Unit S °^ <br /> � �� <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision P � -� <br /> Garage 1 ,�.� <br /> �y 7 <br /> Structure Use: ` � Q/� � ��/ �� <br /> (family trome/cabin,garage,addition, etc.) � <br /> O �� <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 <br /> 2. Show the location of the well (W),septic tank (ST),and draiMield (DF). � 3 <br /> 3. Showdimenslonalnfeetofthefollowing:(a)bulldingtoalllot lines,(b)buildingtocemerlineofroad,(c)building � Z o <br /> measurement to the ordinary high water mark of lake,stream,or river. o n <br /> 4. M separate plans are submitted by an archltea,engineer,builder,contractor,etc.,the plans must be signed and A (� H <br /> dated by the owner. m -C <br /> PLOT PLAN /��G� �R�� G _ / l� r � � CI\ <br /> y �� �� � '�"� lkD �� <br /> ��, ,S� <br /> N <br /> ��t <br /> ���,� , <br /> 0 <br /> �- — �6 _ _____ _ --��/ ,� — <br /> /` o � <br /> ��r � �' <br /> r � <br /> I � <br /> T�.Spet . do G\.,�e 11..,� �.�f1 r,5 a a <br /> �$-t1' O <br /> A o c � m m � a £ � <br /> m. � g.� mnw > = 7g <br /> N <br /> _ N : � <br /> r m <br /> 2C/-1C �: m n C <br /> g : a c <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knows- � S � m m � ; 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- � e,m w O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- $m u <br /> manon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g m $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in lois ap- �, <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to nave � n N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. � m $� <br /> q � € g ^ w <br /> SIGN HERE - - � - 1 / / ~ w w <br /> (signature of owner o in n i � � <br /> ZONING ADMINISTRATOR � � � � ---�-"�--_--�� ` $ ' <br /> TOWNSHIP PERMITS MAY BE REOUIREb JU� '� � « w T <br /> 2 ' il I 888888 <br /> �I �., <br /> i <br />