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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator c - o o <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 u <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 County Ordinances and the laws and 3 a <br /> re uI tions of the <br /> lI State <br /> eeloff Wisconsin. (� L H m <br /> � a fd I N) ���(� 1� 1�Q/ ��(l�l > n `O <br /> Ovy{vER (Pleas rint) Contractor or s�rveyor or Agent o <br /> ' l��a.��Yl� , s,-, �)2. <br /> AdSitespC'-(j <br /> Addrr�_ 1� t, <br /> �FI. )Ca, 111/U �� 13� (�fafr. UUrq . <br /> City State, Zi ode City, State, Zip Code SU <br /> L4- D-lcly IQ <br /> Telephone Larrabee— Coad---. Telephone <br /> 1 <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as indicated on tax statement) o <br /> Permit(s) Applied for: <br /> Dwelling Addition Filling/Grading Camping Unit 0 <br /> v <br /> Z p <br /> Accessory Building Sanitary P 'vy Subdivision P $ <br /> Garage l <br /> Structure Use: IBJ/ I a� l ��(� � e✓ P l <br /> 0 <br /> (family home/cabin, garage, addition, etc.) <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). O <br /> 2. Show the location of the well (W),septic tank (ST),and dralnfield (DF). C 3 <br /> 3. Show the location of any lake or flowage- it within 1000 ft. and the location of any river or stream- if within .1 ? m <br /> 300 ft. on Z `v <br /> 4. Show dimensions in feet ofthefollowing:(a) building to all lot lines,(b)building to center line of road,(c)building n P s <br /> to lake, river or stream, if applicable. M <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C I <br /> dated by the owner. <br /> PLOT PLAN <br /> A �,ac <br /> su <br /> �J L <br /> 77\- <br /> ICT <br /> o <br /> I0 <br /> o Y � <br /> m <br /> o <br /> w <br /> r I� <br /> Z <br /> S <br /> I� <br /> m <br /> �. Dai 3aN = - 3 <br /> Z mo � and -1 <br /> a <br /> c� 2 o <br /> 8 a = c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m ' - a <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible forthe detail and accuracy of all informs- y, m <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. 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- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have a <br /> access to the above described premises at any reasonable time for the purpose of inspection. m g <br /> - - YY�/'✓I �V L V Np <br /> SIGN HERE �+ <br /> ( ' nature o owner or building contractor) (date) o ) P <br /> ZONING ADMINISTRATOR <br /> ) <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> N {Nl i N N 0 0 0 m <br /> 8888 $ 8 $ $ ai <br />