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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratord o 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 v <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 '' <br /> regulations of the State of Wi cousin. <br /> c <br /> OWNER(Plea/$�e Print) .r Contractor or Surveyor or Agent o <br /> eCJ�/J�Q5' Address <br /> `o N Cie C�` <br /> ' ess <br /> /"O6 'Z/E/( SY(ZO/1 W <br /> City, State,Zip Code S2:20City,State,Zip Code <br /> i <br /> 7 S G 3 f <br /> Telephone Telephone ' U <br /> Emer =Fi2 . anl&oad Namk/ /_ <br /> -Sadr <br /> 57td{e S <br /> Legal Description (as Indicated on tax statement) o <br /> O <br /> Permit(s)Applied for: <br /> Dwelling Addition Filling/Grading Camping Unit S <br /> t <br /> Z p <br /> Accessory Building Sanitary Privy Subdivision m <br /> Garage ' <br /> Structure Use <br /> f��/� /tel/</, I /` a0 I o <br /> (family home/cabin, garage, addition,etc.) <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). <br /> 2. Show the location of the well (N),septic tank(ST),and draiMield (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 n <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m m <br /> dated by the owner. <br /> C <br /> PLOT PLAN M <br /> c o <br /> 7 ' <br /> 00 <br /> 0 <br /> I <br /> m <br /> I I <br /> Z <br /> /OO <br /> f <br /> --�_ <br /> 151 - m N N V U., n <br /> v < � 0om3 <br /> -- <br /> o o : <br /> f T y: ij <br /> c » <br /> In <br /> $ nS 3 <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- S i° r, <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 900 <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g 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 aboveed premises at any reasonable time for the purpose of inspection. m g <br /> A a A N <br /> N N O <br /> SIGN HERE `;' a <br /> n re of own uilding contractor) (date) �+ <br /> o . x : <br /> ZONING ADMINISTRATOR g `. <br /> H <br /> TOWNSHIP PERMITS MAY BE REQUIRED rn rn NNn �?n o o 99 r <br /> 888888880 <br />