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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator co a o <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 y <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m 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. H m 1 <br /> ZA / ll�l n O <br /> O ER Please�n � �—��-1 Contractor or Surveyor or Agent o <br /> 471 o <br /> �n 1 1vf� v� �P> m <br /> Address r Address LK <br /> City State, Zip Code City,State,Zip Code <br /> TelephoTie � lephone <br /> 93 <br /> Emergency/Fire No. and Road Name <br /> �tion Descri <br /> Legal s indicated�n tfyM_statement) <br /> 9 P <br /> Permit(s) Applied for: O - —• <br /> Dwelling Addition Filling/Grading Camping Unit <br /> v 3 z o <br /> Accessory Building Sanitary Privy Subdivision m <br /> Garage <br /> Structure Use �p�' o <br /> (family ome/cabin, garag , addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: G <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). M O <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). C 3 <br /> 3. Show the location of any lake or flowage- If within 1000 ft. and the location of any river or stream-If within o c <br /> 300 ft. In z <br /> P a <br /> 4. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building n y <br /> to lake, river or stream, if applicable. ftl 1 <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C <br /> dated by the owner. 10 <br /> PLOT PLAN K/4tAIC t- <br /> 12CnIO <br /> 46 m <br /> ff r u/� <br /> 70 <br /> �NOW Nd Ad&f w s of-ar <br /> we Lt f fb 6�m4e 1p <br /> I /2Xi5" N, � f <br /> 1 in o c w n F T <br /> n m <br /> i m. aa� ao- Na _ a <br /> - - - _ <br /> Z oo : "zFi <br /> : � <br /> m <br /> t"n [ moo : O <br /> c <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 1 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- 8 m rn <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 O <br /> access to the abov ribed premises at any reasonable time for the purpose of inspection. m 8 m <br /> T i 3 n <br /> m v A e i <br /> SIGN HE ! <br /> 44�1sign o ner ilding contractor) c / t o s <br /> ZONING ADMINISTRATOR ` 8 <br /> A <br /> 51991 <br /> TOWNSHIP <br /> TOWNSHIP PERMITS MAY BE REQUIRED N 8 N 8 8 `d m <br /> o <br /> 998888r <br />