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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratord W 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 H <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the c <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and - n <br /> re ulations oft a Sts 6 of W' con in. w m <br /> l I ✓�� dl: 1 n f <br /> O R Tleaad�i / / Contractor or Surveyor or Agent o <br /> A ss Address <br /> V — � L/ S � / <br /> City,Sate Zi,�ode�}y City,State,Zip Code r <br /> Telephone Telephone ^ <br /> Emergire and Road Name <br /> /l C _ri s <br /> Legal Description (as Indicated on tax statement) ¢-m <br /> n C <br /> 0 o <br /> Permit(s)Applied for: — <br /> E Dwelling Addition Filling/Grading Camping Unit 7 0 <br /> Z `r 0 `7 <br /> ccesso Buildin Sanitary Privy Subdivision 3 <br /> _Garage <br /> Structure Use: ' + <br /> (family home/cabin, garage,additti n,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). O <br /> 2. Show the location of the well (W),septic tank(ST),and drainfield (DF). 3 \ \ n <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 Q <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 M ; VV <br /> o <br /> dated by the owner. C �r <br /> PLOT PLAN �p' j .� (I( fi �L �'� <br /> a <br /> C O <br /> 7 I <br /> o <br /> u Pe if <br /> ^N <br /> , Z <br /> �ZJ <br /> �ry 9 o c m m o n V T <br /> FL 33 <br /> o. : Z uC <br /> m' i Q m ; <br /> m <br /> meg : o <br /> 3 i € C <br /> mm : a <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o 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- w m vi O <br /> tion contained in this application(including any accompanying scheduie)and I further declare that I recognize that this infor- m ro <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I a. <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have g <br /> access to the above describ premises al ny reasonable time for the purpose of inspection. m <br /> SIGN HERE <br /> (sig ur of owner o Idin contractor) 1, 'i `. -(date)! o x <br /> ZONING ADMINISTRATOR �3 il: ` w <br /> APR • I �N � oo0m <br /> TOWNSHIP P RMITS MAY B'E/ REQUIRED 8 8 888880 <br />