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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ° o 0 <br /> APPLICATION FOR — LAND USE — PERMITS • 3 m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 11 y o d� <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. a ,U <br /> regulations of the State of Wisconsin. y o -�- <br /> N• c° <br /> CD <br /> a _i)� FO <br /> OWNER (Please Pri ) Contractor or Surveyor or Agent 5 r• - �, m <br /> C\ r <br /> ddres Address <br /> cN,...A <br /> City, tate Zip CodeCity, State,Zip Code <br /> Telephone Telephone <br /> 1\5—Cp' s- —a gar <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as indicated on tax statement) o <br /> o ✓ <br /> Permit(s) Applied for: o 0 <br /> P(. o ° <br /> Dwelling Addition Filling/Grading Camping Unit i ..\ <br /> -o <br /> z <br /> Accessory Building Sanitary Privy Subdivision 0 l <br /> Garage J <br /> Structure Use: 1 -X --- c\W-Q\`` '‘ o <br /> (family ho�/cabin, garage, addition, etc.) <br /> en <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) M <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 drainfield (DF). <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building EN • Q <br /> measurement to the ordinary high water mark of lake,stream,or river. — o a <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m yvi <br /> dated by the owner. C '-- <br /> PLOT PLAN m _ <br /> j <br /> I 1S2:) �c--) I CD <br /> �o©�- ��d C7 o <br /> N / <br /> 7 i/ <br /> Fi <br /> \) l'1:- ...3) <br /> Z <br /> I <br /> 03s <br /> -(1 <br /> -I <br /> ti <br /> T..N_^, 1`...1 <br /> % 33 ww -ocnrDD013 <br /> _ _ v oaf m <br /> .0 CD Z <br /> �e. G . ".7— N 0 7•co <br /> ��u: <br /> j,+NOZ -,i <br /> g0 <br /> g 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 fD m m <br /> fl <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- En m N 0 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i •g ro N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I -Ti 8 '' 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- d, <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have ^' <br /> access to the above described premises at any reasonable time for the purpose of inspection. m $ v <br /> m 3c' <br /> CDCD 0 A co <br /> h N 8 <br /> SIGN HERE ;' o <br /> (signature of owner or building contractor) (date) o-.: <br /> ONING ADMINISTRATOR _ (71 �t��� � g <br /> _, �'i fA 69 Fn fA to fn T <br /> TOWNSHIP PERMITS MAY BE REQUIRED - 4 rN 0 c^'' o 8 8 m <br /> 88888888n <br /> (Abe ;e,C,i ,- (3-R <br />