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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 5 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � w <br /> E <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 a <br /> regulations of the State of Wisconsin. w m <br /> C <br /> �SCLF n f <br /> OWNER (P%se Print) �} Contractor or Surveyor or Agent o <br /> Address Address <br /> C'' State,Zip Code City, State,Zip Code <br /> /�AA/R,//zV IA/In .5X.P30 <br /> Telephone { r� Telephone <br /> Emergency/Fire No. and Road Name <br /> 3002 7/ ,V. 70-Xuc. <br /> Legal Description (as Indicated on tax statement) <br /> Permit(s)Applied for: o °. <br /> m � <br /> Dwelling Addition Filling/Grading Camping Unit °» <br /> Add df v <br /> (hzui�lai Zo <br /> Accessory Building Sanitary Privy Subdivision oma, <br /> GarageC _-D <br /> Structure Use: o <br /> (family home/cabin, garage,addition, etc.) <br /> 1A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <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 drainfield (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 ifZ 1 <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 N <br /> dated by the owner. <br /> C I <br /> PLOT PLAN (4 <br /> p.� o <br /> lT� <br /> 0 <br /> 0 <br /> �. <br /> 6-orG 3>; <br /> >300 <br /> I z <br /> I � <br /> f <br /> e c a m An <br /> N M <br /> -6 a< . ° c b 3 <br /> Z m o <br /> In <br /> rni V7� O <br /> 8 a <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- S m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i i <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 C' 8 a <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 ,„ <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 8 <br /> m : 3 yA w <br /> N ypp <br /> SIGN HERE. (Big tur of owner or Ing ntractort (date) c <br /> ZONING ADINISTRATOR <br /> H <br /> TOWNSHIP PERN ITS MAY BE REQUIRED L ro 8 0 o o S' m <br /> 98888888rmn <br />