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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratora o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and H r, <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 0. <br /> regulations of the State of Wisconsin. y m <br /> a'41 A.9' 607`nErrnt 1 f –7"ee–r S9r4e 45 owner a f <br /> OWNER (Pie se Print Contractor or Surveyor or Agent v b <br /> 79c IQ it ve. <br /> Address M Address <br /> S r In 651044 t� �( <br /> City,Slate,Zip Code City,State,Zip Code T , I <br /> �!a aa7 c3 l <br /> Telephone Telephone l <br /> a i 4�(S CoN� 4 Rood M <br /> Emergencnr/Fire No.ofand S Road/y Name <br /> E %y W .� Sec+�o.+ ! - Tr�e 4c ke Tou+,u_j p <br /> Legal Description (as indicated on tax statement) <br /> 0 <br /> Permit(s) Applied for: o °. <br /> o -- <br /> Dwelling _X Addition Filling/Grading Camping Unit S <br /> v <br /> z d <br /> Accessory Building Sanitary Privy Subdivi 'on o $ <br /> Garage l <br /> Structure Use: l4r91 140en o <br /> (family home/cabin, garage,additio , e .) }- <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) M Ian <br /> µ.iV <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfieid (DF). 3 <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building I z v <br /> measurement to the ordinary high water mark of fake,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 y <br /> dated by the owner. 0 <br /> C 1 . <br /> PLOT PLAN NT <br /> Co Nk 11P\11 I' n <br /> 0 <br /> 9J <br /> 6 m <br /> o' <br /> L <br /> ri WA 0 o <br /> 0 <br /> A tig�ro 7j,r .. <br /> roe n oe j <br /> fJB �0 c=n>� I�ue o{ •Q of x 3 N8 1 <br /> N6 -10 c,,,,-i{\ l.pt IIUc 0.prof 1170 <br /> N6 �• GkYI"Lot IiNe nProc \Doo jn X44 ® z <br /> 4t. C& Ire -1`7171 \So . «I 9.P X <br /> N•� r+ <br /> r1¢ -(n Fast Lot link o.Prmt <br /> NB 4o -PbNS r.Pro}t 310 <br /> V,lc l I �o Sapa.c�• k Y" 110 <br /> �ro,N �iel� a� 200 yo�w� <br /> p.rA .s �'rwuo Sit rp bmnK SrOw 6 ;14,Ng Sia <br /> D r/I rA > v V <br /> a.0 a y <br /> p M <br /> G H' N O <br /> Z A o e .2 : <br /> I,Jr lit - 1+`I :fGil ut 'n tai C <br /> 0 C i C <br /> 1 declare that this application(including any accompanying schedule)has been examined by a and to the best of my knowl- g '�° 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- 0 ; O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- . `,d m u, <br /> malion I am providing will be reliedupon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 LJ1J $ 0 $ <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 m N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> 3A <br /> Am <br /> a <br /> SIGN HERE /r� �.Ca 8 ' <br /> (s' natu of owner or 'Iding contractor) - �� — (date) o <br /> �_ <br /> ZONING ADMINISTRATOR g ' <br /> TOWNSHIP PERMITS MAY BE REQUIRED u a u u o o SS rTn <br /> _8888888 ai <br /> l� <br /> CTC `' i1' <br />