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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d � 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 — <br /> ° CJ 1 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the St to of Wisconsin. w ,�, <br /> l m <br /> Ivn� oa marls � Nrti 1,111 1"1 uhd , ed� � a <br /> OWNS(t (PleaseP,r-ii��tt) —� Contr t rorSurveyororAge t �X o <br /> Aess�P6011ep, DO J17 WT _6VI?d <br /> !/ <br /> City,- tampCode City, ate,Zi Code <br /> l 3 -5 — a�.s �3 <br /> Telepho Telephone <br /> �errry �ahc � <br /> Emergency/Fire No and Road Name <br /> Legal Description (as indicated on tax statement) o <br /> Permit(s) Applied for: 0 0 <br /> Dwelling Addition Filling/Grading Camping Unit S °^ <br /> v .( � <br /> Z V <br /> Accessory Building Sanitary Privy Subdivision ° (b <br /> Garage S <br /> Structure Use: rl LILL L -f 0 5 <br /> r <br /> (family home/cabin, garage, addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: I <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). n ) <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). G 3 <br /> 3. Show the location of any lake or flowage-if within 1000 ft. and the location of any river or stream-if within P m <br /> 300 ft. o n <br /> 4. Show dimensions in feet ofthefollowing:(a) building to all lot lines,(b)building to center line of road,(c)building <br /> to lake, river or stream, if applicable. .� o <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C <br /> dated by the owner. m __ <br /> _ II. <br /> PLOT PLAN C9 <br /> �L <br /> on <br /> r _ <br /> 1 0 0 <br /> CahJ t_.rt <br /> Z <br /> �) Aft ek-aj�j A4eci_ b A S("Pe O� WA, l,i Fo�,-,4 �' 7� Lr j�, n,,.-si- be <br /> co�e� laWl� my ,$o. / � Seed,:P, c- YYbcaGu�, <br /> FYI. �� Cl%UL'veX ♦ S 2¢t�� IQ-17 /"YTic_ Y2uL� �: <br /> 2. <br /> -yJ r a__ m _ 3 <br /> rllG+v M`- . ♦- �G. S�2w„-9�, �N� O.v <br /> 3-Do, <br /> Z-4/ o0'o ? m„°z a 1 <br /> O _ S/ fesQ (�L� fes : n : m <br /> }Vo GtA/2 err d l2e� v, �� T46 3 o <br /> ;ti <br /> I declare that this application(including any a companying schedule)has been examined by me and to the best of my knowl- o E 0 m m <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informa- <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. 1 14� g <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 /> w <br /> access to the above descri d premises at any reasonabl a for the purpose of inspection. 8 m <br /> T 3 <br /> � 0 . <br /> m a m <br /> g <br /> SIGN HERE w t ; <br /> (at u of owner ori Ing contrac o x <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PER TS MAYBE REQUIRE / MAR 7 N N N N N 0 0 0 m <br /> /��� s );'�� 88888888vmi <br />