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7y <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; -- 0 <br /> APPLICATION FOR — LAND USE — PERMITS ' 3_ <br /> m ro <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and H c <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 n <br /> regulations of the State of Wisconsin. <br /> IC41AQ1� [1►�ImPtl¢ ' 1ti�� K1�L �lAl\�e�5 a ° <br /> f <br /> OWNS (Please Prim Contr ctor or Surveyor orpgent <br /> k I �G�( �1� S (YWinr51 , P.U. 13�x�S1 � xJ <br /> Address Addre s <br /> LZCUYt Rl AIV , 6600-7 u� <br /> City, State, Zip Code City, Sta�tg,Zip Code <br /> o 7-g.3) - 4aSq <br /> Telephone 5t qg0ll Telephone C' <br /> Emergency/Fire No. and Road Name Y <br /> Legal Description (as Indicated on tax statement) 4 <br /> O <br /> Permit(s) Applied for: ( o` It. <br /> N O <br /> Dwelling Addition x I Filling/Grading Camping Unit o <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision 09, <br /> Garage <br /> Structure Use: s�_D�ObYv� <br /> (family home ab n)garage, addition, etc.) <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 (N). 0 <br /> 2. Show the location of the well (W),septic tank (ST),and drainfieid (DF). 0 v <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building Z c <br /> measurement to the ordinary high water mark of lake,stream, or river. o n <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m y <br /> dated by the owner. C h <br /> PLOT PLAN M <br /> to 67 <br /> f 0) <br /> o <br /> lucLG <br /> i i; <br /> J o <br /> r r <br /> y <br /> -7j,hopI <br /> i tfi'a <br /> IVA)15 I tLLO <br /> L ,� p 1 D NN V (nr DDp V <br /> oTleti O I�MA'I n —o > > o n F m <br /> �. Dnp 0 " "° y <br /> � � -lo bt p) least a < - . 'R « "o13 3 <br /> Z 3 o mQI: 1 <br /> s <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. o m '� 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. a m w O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor $ mi <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g 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 u,' <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 3 82 <br /> ro V A u <br /> m <br /> SIGN HERE <br /> (sign r oto r wilding contractor) <br /> ZONING ADMINISTRATOR �y�[pp a CI [ g <br /> f� <br /> TOWNSHIP PERMITS MAY BE REQUIRED ` 4 N 8 n o o 0 m <br /> 8888988y <br />