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N evv T <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m - o 0 <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 � <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. y o <br /> HOWA-Ro KREe- - V�pSSEI-T C©dsT, a o <br /> 009 NER (PI ase Int C rac r or urve_yor or A nt o <br /> dress A dress t <br /> r1L^RU . wl ' 59001 0-SCE—OL-8 - WI 54020 0 <br /> City, State,Zi Code 1te Z�C S' <br /> 1 S <br /> Telephone Telephone J <br /> *, ark ►nes . Y43 -3991 7�1 <br /> Emergency/Fire No. and Road Name 0 <br /> Legal Description (as Indicated on tax statement) - o <br /> Permit(s) Applied for: o < <br /> Dwelling X Addition Filling/Grading Camping Unit o °^ <br /> v I <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision o 9 <br /> Garage .,,f n <br /> Structure Use: 0, ` 6 SigM V-�fp'- - — <br /> (family home/cabin, garage, ition, 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). 0 Imo' <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 3 <br /> 3. Show the location of any lake or flowage-if within 1000 ft, and the location of any river or stream- if within9 w <br /> 300 ft. <br /> a ' 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 � <br /> to lake, river or stream, if applicable. <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C T 1 <br /> dated by the owner. M <br /> / m <br /> PLOT PLAN e74- c44(, y oa oh �a9 9/ <br /> { rl7)yr. <br /> � c C/ <br /> $ql � <br /> Riker -,D reef seq ��n� �«e,��, <br /> y �� ✓e w lur 11 <br /> heed � Le. 6Y04! m <br /> IT�o ordr'nanch� <br /> racL rr'y-� a6t(/IQ1�1 N r' <br /> ff r C(earance , 7C <br /> 1Tr44e�ede�S�Q6117 <br /> n Ce(Qa q�tce /3 9 <br /> �6 r � �aSe��° TrVe✓. Ile <br /> � m � <br /> o � <br /> -��rPserue �encl?marK, � O <br /> C> <br /> LA Z <br /> Pa M <br /> I <br /> �� <br /> s <br /> 0)5) <br /> ,(�lei 'l D rnrnvmmmr DDp <br /> /v I M1-� yn, /�� ��N / M oc . oaF2. <br /> a <br /> m <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- : m <br /> 9 P 9 P Y y!a w O <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.1 agree to permit county officials charged with administering county ordinances or other authorized person to have N E <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 8 m <br /> m : A o <br /> SIGN HERE F-PFn m <br /> (signature of wner or building co ra tor) (dat ) <br /> P <br /> x: <br /> ZONING ADMINISTRATOR <br /> 36 a 8 <br /> Iry <br /> TOWNSHIP PERMIT MAY BE REQUIRED o o <br /> 88 8 <br />