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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a <br /> H <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 r <br /> regulations of the State of Wisconsin. m m <br /> �orrl Sol �nlgQr 5 we (_¢ w.et� �et�cSofJ C o t)Sr (_ a a C O <br /> f <br /> Ov�NER LPlease Pr Contractor or Surveyor or Agent o <br /> Address Address <br /> bt�i�buru vJ\Sc, v.>xbsrter vJ�s� oc �- <br /> City, State, Zip C de City,State,Zip Code z) <br /> 5��630 54 B93 K 0 <br /> Telephone Telephone <br /> n)s - 11666- 71a4 <br /> Emergency/Fire No, and Road Name <br /> Legal Description (as Indicated on tax statement) <br /> n 1 <br /> 0L <br /> Permits) Applied for: 0 ^. <br /> w � <br /> Dwelling Addition Filling/Grading Camping Unit71 <br /> ° » <br /> Z o <br /> Accessory BuildingSanitary Privy Subdivision ° <br /> Garage <br /> Structure Use: N Q�,� 1QvNQ <br /> (family home/cabin, garage, addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: 21 <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 drainfleld (DF). C 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 'Mill <br /> 1111 e 0 <br /> 300 ft. o n <br /> 4. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building m (h o P <br /> to lake, river or stream, if applicable. <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 /> PLOT PLAN R.) -r <br /> r 1 <br /> VJ Q m <br /> l m <br /> o <br /> m <br /> LA » <br /> oma. <br /> tJ d <br /> ' e �. <br /> S I O' .. - <br /> - �� o <br /> Ofe— 51,62 ee kf1 of <br /> p <br /> y� 'I fOm �l o. a m a F m <br /> y <br /> tda <br /> Z rD T. : m .z f� M 3 c m <br /> 017 l3N <br /> v'd C%CA�swre � . € o <br /> c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- S ; m ii�' ; 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- P t <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 m 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 O o <br /> access to the above described prg3 , at any reasonable time for the purpose of inspection. . m 8 , <br /> m ' a A m ' <br /> m m <br /> SIGN HERE <br /> (signet of owner or Wild in contractor) < < tdate): ? o [ <br /> ZONING ADMINISTRATORbii <br /> TOWNSHIP PERMITS MAY BE REOUI NOV - 6W j 8 <br /> II, 11 �., <br />