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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratord m o <br /> APPLICATION FOR - LAND USE - PERMITS 3I r <br /> . <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 2 c <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 <br /> regulations of the State of Wisconsin. �, m <br /> N � <br /> Pat and MaAq CAawLetf a f <br /> OWNER(Please Print) Contractor or Surveyor or Agent o „ <br /> 921 Wiftow Ridge'. Road <br /> Address Address <br /> H(A hOn, WI 54016 <br /> City, State, Zip Code City, State,Zip Code <br /> (715) 386-5404 <br /> Telephone Telephone C) <br /> Emergency/Fire No. and Road Name <br /> ct. Gov. Lot 3. SPct.inn 900 T30N R14(j), Tnun nA Roatt <br /> Legal Description (as Indicated on tax statement) o <br /> Permits) Applied for: o <br /> C. <br /> Dwelling Addition Filling/Grading Camping Unit S <br /> v <br /> Z o / <br /> Accessory Building Sanitary X Privy Subdivision °_ <br /> Garage �J ,/ � <br /> Structure Use: Sang taAy 6(k i L.l l iy6 PPS+ ? U\ <br /> (family ome/cabin, garage,addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) X <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). 9 <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). 00 N <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building q Z c <br /> measurement to the ordinary high water mark of lake,stream,or river. o 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. (Sc 0 <br /> C <br /> PLOT PLAN M V, S <br /> qjG <br /> I <br /> SEE ATTACHED ? <br /> m �o � <br /> N <br /> I� <br /> Z <br /> 7J <br /> o c m m <br /> n F <br /> m -a� nam az. A y <br /> 00n003 <br /> F T N in <br /> = m <br /> N � 2 D <br /> 8 n c^ C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 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- w m w O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- S m N <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ e 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 n N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m $ m <br /> m 3 A p <br /> SIGN HERE (wade RIA dI10"QY11 <br /> (signature of owner or building contractor) 01 LJ (date) /✓ I L <br /> ZONING ADMINISTRATORTOWNSHIP PERMITS MAY BE REQUIRED IM R 0 o o 8 m <br /> j <br /> 38 <br /> 8888888m <br />