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Lil I (✓(DIY i�J �. <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o/ o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d a <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable.Founty di nces nd the laws and 3 n <br /> regulations of the SUlte of Wme%in. \ a m <br /> \I A <br /> 7 $ O <br /> F <br /> OWNER (Plea tint aor oSury or A t o <br /> 220-251 -TbaJ647r) m <br /> o m <br /> Add�eys k �Aj ess <br /> I <br /> City,State,Zip ode e, ip Code 1 <br /> Zr�Y� <br /> Telephone Telephone <br /> Emerg c Fire No. and_Road Name <br /> 5 � iron jn Saj Y <br /> Legal Description (as Indicated o tax statement)--, o <br /> � O <br /> Permits)Applied for: o ° <br /> m r <br /> Dwelling Addition Filling/Grading Camping Unit °— <br /> v <br /> Z v R <br /> Accessory Building Sanitary Privy Sub ivision P a <br /> Garage 3 1 <br /> 1 <br /> Structure Use: "'1����JJII (1L 1 t � <br /> o <br /> (fai home abin, a e tldrt , etc.) <br /> DIRECTIONS FOR PLT LAN DRAWING: (Aerial or top view) <br /> 0 Q <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 '111111 <br /> 6 v <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 I H <br /> dated by the owner. o <br /> C <br /> PLOT PLAN m <br /> y� iwc,� <br /> J �1 <br /> N <br /> c o <br /> �^ a � U <br /> sm <br /> ( <br /> D 2 <br /> 0 V1gnw DD <br /> �_- o c o. ro m a n m <br /> Z < H ami °Oo 3 <br /> �U�r i Sa fake P I M <br /> € C <br /> z <br /> g ' i A : i s <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- g : , 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- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i5 n i1 <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 gag <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 'th administering county ordinances or other authorized person to have n 00 <br /> access to the above described premises t any re o ble time for the urpose of inspection. T a g <br /> a A a <br /> m yp <br /> N O : <br /> SIGN MERE H: $ <br /> (sign f owner or ing contractor) (date) c x 9 t <br /> ZONING ADMINISTRATOR �� g <br /> N <br /> TOWNSHIP PERMITS MAY BE REQUIRED R $ o o's 'Mn <br /> 88888gggm <br />