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nett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator N 1 Z <br /> APPLICATION FOR — LAND USE — PERMITS m ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w J <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m`m ° <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3. o- <br /> regulations of the State Of Wisconsin. <br /> OWNE Please Prl t1 Contractor or Surveyor or Agent 0 n <br /> iS�ss J.1'• r ? <br /> Address R4' (7/�C/� m <br /> �1 M 6'�OIiLcr <br /> Clty, State,Zip Code �� t <br /> City, State, Zip Code <br /> Telephone <br /> S// Telephone <br /> c/ — �jllo '^F'>�/ S7 � <br /> Emergency/Fire No. and Road Name _ �Q <br /> Legal DescrilNlon (as Indicated on tax statement <br /> 0 <br /> Permit(s)Applied for: o <br /> o` < 1 <br /> G <br /> Dwelling Addition Filling/Grading Camping Unit o _ -" <br /> Accessory Buildin Sanitary Prn'1' Subdivision <br /> Structure Use: <br /> } <br /> (family nome/cabin, garage, addition, etc.) o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (t�. 0 <br /> 2. Show the location of the well (W),septic tank (ST),and drainfleld (DF). Q ° <br /> 3. Show dimensions In feet of thefoliowing:(a)building to all lot lines,(b)building tocenter line ofroad,(c)building � � c <br /> measurement to the ordinary high water mark of lake,stream,or river. z rn <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> ° o <br /> dated by the owner. f7 <- <br /> M o <br /> PLOT PLAN M <br /> m <br />�UlLS <br /> LAl z36-'a " � C <br /> i <br /> r ao Esau -D <br /> l'�Mtab. 8 <br /> 30' Jm1tN z <br /> o <br /> OWU 4WI Rlv <br /> "Vow PL fro' <br /> si <br /> 33' zz� <br /> 7&1-i <br /> �! l cn (A V fAr DD <br /> 2.-6Kf Z- �f D o c . m m m a g y <br /> m <br /> n'5 >. a m <br /> a_ < 3: 4qo � �' ; <br /> ON <br /> z o <br /> 4 : . <br /> Z / i LO o > „ u [ m <br /> s �2f O <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- g 'm y <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- m <br /> tion contained in this application(including an accompanyingschedule and I further declare that I recognize that this infor- m m <br /> PP ( 9 Y 1 g gm <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which may a result of the County of Burnett ing on this information I am providing in this ap- <br /> plication. I agree to 't count ' ials charged with administer my ordinances or other authorized person to have <br /> access to the abo de ribe r ises any re a time h purpose of inspection. <br /> SIGN HERE -'� r <br /> (signs of own r or build' ontractor) date) u E <br /> 9 V <br /> ZONING ADMINISTRATOR <br /> JLT_�FMIGfth/ <br /> 8 i <br /> TOWNSHIP PERMITS MAY BE REQUIRED to rml 0 8 o o m <br /> 88888888mw <br />