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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U) 'a 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <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 a (O <br /> regulations of the State of Wisconsin. H ,� / <br /> SAcREA SnaRTS CATlfo,_ IC CAURcN _ 0, K. 6oVSiRilci rolt/ a " F <br /> 0 NER PleasePriM) Contractor or Surveyor A ent o ', <br /> o, �3ox � cy� �sz�2 'ag39 s C� A� l+�l25y 2t <br /> Address Address ` <br /> � Wl -Sy��/��0007 SPoc�lU��2 �w� s4�ol <br /> City,State,Zip Code City, State,Zip Cotle <br /> fZ(�1a�73� 1 lo3s-7jD 1 <br /> Telephone Telephone <br /> �8�I�n '. .kt�, 44 <br /> Emer�enc /Fire No. a d Road Name <br /> _ f ", l% Sr. 16 -rwA/ NN /6F_ ty TowA/ oFSCnTi <br /> Legal Description (as Indicated on tax statement) o <br /> n L7 <br /> 0 <br /> Permit(s) Applied for: o <br /> '^ r <br /> Dwelling Addition Filling/Grading Camping Unit o ° <br /> M <br /> z o <br /> Accessory Building Sanitary Privy Subdivision ° <br /> Garage — <br /> Structure Use: & 6 R f) 6-E <br /> (family home/cabin, garage,addition, etc.) <br /> 0 <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). a <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (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 c <br /> measurement to the ordinary high water mark of lake,stream,or river. o a <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and A n' <br /> dated by the owner. m0. <br /> PLOT PLAN 2 F 5C_ F Al T m <br /> O <br /> N <br /> » <br /> O <br /> �0 0 <br /> 0 <br /> 34, Lv' vy, �zti l0 <br /> W d <br /> z <br /> C' MB !p <br /> U / � <br /> w � <br /> ) 1 <br /> oc � m m <br /> m. Da•� ' 2 m amM <br /> a < Z m o m 3 <br /> 2 m e m Z y <br /> f M m M <br /> N n D <br /> 8p 0 " r. <br /> : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- ` 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- = m <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. I <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 3 <br /> N <br /> SIGN HERE_P_&=2 a <br /> (sign e f owner rui ding con tr ctor) c , <br /> ZONING ADMINISTRATOR ll g <br /> MAY 2 21992 a <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> X888 8 $ a) <br /> i <br />