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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratord 0 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3 0 <br /> w <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and y <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 State of Wisconsin. y <br /> r )o Ft'1 cLU�'Y1.yQw t lld��E�Y 4, a O <br /> F <br /> OWNER (Please Print) Contractor or Surv0dr or Agen o <br /> R-C9- S4 3x q-7; A <br /> Addr ss Address <br /> CxcolStor (1 1 xn 55 3�1 ry, S atem <br /> ._o�t� t J : 54 501 �\ <br /> City, State, Zip Code Ci <br /> , Zip Code I <br /> -]f S- te��-1y �L <br /> Telephone Telephone O� <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as Indicated on tax statement) o / <br /> n � <br /> Permit0 <br /> Permit(s) Applied for: o <br /> Dwelling Addition Filling/Grading Camping Unit ° <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision ° m <br /> Garage 1 �. <br /> Structure Use: ��/1 1 8 4x – C) o <br /> ( mily home/cabin, garage, addition, etc.) --r; <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). 0 <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (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 a W <br /> 300 ft. ZQ <br /> 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 n <br /> to lake, river or stream, if applicable. m o <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C 1 ' <br /> dated by the owner. 40 M (,� <br /> PLOT PLAN <br /> I � <br /> C—) <br /> y <br /> m <br /> n <br /> a <br /> N nl <br /> I » <br /> � � ) �2191L-5/ �P�1111GQ �CcT2 -totlAuJ TOL l �J <br /> WtL-j LA)0� ( Q <br /> S S 'So u," &-rl --row r1 � 112 t l_Ow <br /> A o c m m D a F m <br /> m_ DK 9o- 00am p <br /> < < H o tp <br /> Z A 0 : m Z : 1 <br /> a F ' T N IJ <br /> M <br /> O <br /> g c : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o '� 9 <br /> 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- $ 'm N <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 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- N <br /> plication. I a ree to permit coun officials charged with administering county ordinances or other authorized person to have u, <br /> access tot above described emises at any reasonable time for the purpose of inspection, m g <br /> m 3 0 <br /> n �iC H N 8 : <br /> SIGN HERE `�'� b– y� 0w : ^ <br /> (signala owner or b 'I ' g contractor) (date) o , <br /> ZONING ADMINISTRATOR r� , 8 . . <br /> ( TOWNSHIP PERMITS MAY BE REQUIRED <br /> N N N N 8 8 8 m <br /> 88888888rmn <br />