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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m ° <br /> TO THE ZOt4ING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <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 - <br /> 0 <br /> regulations of the State of Wisconsin. <br /> 51 fn P 0 <br /> OWSE Please riot) Contractor or Surveyor or Agent m m <br /> Add s Address . <br /> � D.PP'eJ lEuJ rn nr S 51.��02a13 n !L-, (11 UQ ' <br /> City,State,Zip Code City,State(Zip Code�rO <br /> T hon Telephone <br /> Emergency/Fire NN;.,d'oo N�Itte <br /> Legal Description (as Indicated on tax statement) /eK <br /> 0 <br /> 0 <br /> Permit(s)Applied for: <br /> w r- <br /> o 0 <br /> Dwelling Addition Filling/Grading Camping Unit c <br /> Z o <br /> Accessory Building � Sanitary Privy Subdivision ° a <br /> Garage / <br /> Structure Use: <br /> r (family home/cabin,garage, addition, etc.) <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 9 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). O <br /> 2. Show the location of the well (W),septic tank (ST),and draintleid (OF). 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 91 c V) <br /> measurement to the ordinary high water mark of lake,stream,or river. I <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and e <br /> dated by the owner. C ' <br /> PLOT PLAN IMII _ <br /> t� <br /> � N <br /> �i <br /> 0 <br /> N L <br /> m <br /> O y <br /> w ItIII(lV�� <br /> .. I <br /> 1 IIIIL�` <br /> I <br /> G <br /> 9 o c m o a g m <br /> m. pDg mnN } � M <br /> <_ ? Z N O m ; <br /> Z @@'c i mZ <br /> O Y ? <br /> u): a <br /> cc : m <br /> C <br /> a <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> o f 0 0' m <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- it ? O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 75 <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ $ [ <br /> further accept sill 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 . <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> M 1,2 O <br /> SIGN HERE (date) <br /> signature of own or building contractor) (J <br /> Flan �a1 s <br /> ZONING ADMINISTRATOR lint N' ' <br /> NNM T <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> m <br /> 8 8 8 8 8 8 8 8 vmi <br />