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'/ 1 I'C .ill / .• <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratord ; ; o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 0 <br /> j <br /> 70 THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 3 r. <br /> Burnett County Land Use Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and _= <br /> regulations of the State of Wisconsin. <br /> L.ON/JIC 002.9- <br /> OWNER <br /> ORR OWNER(Please Print) Cornr4ct r5u�rve�r Agent o �° <br /> 65-10 `-Rrr.L Fitt �Jc. A <br /> Address Addres <br /> ear u.7. S 4 gU LO'. 5-4irO) <br /> City, State,Zip Code City, Stat6,Zip Code <br /> &3S-3o9,3 '715- Cj <br /> Telephone /I __ Telephone <br /> 'M-y0 /-Dta.N �P-.Q— <br /> Emergency/Fire No. and Abed Name • <br /> S[64 SLJ & AVUIk/ Su.. RI'itj E° <br /> Legal Description (as Indicated on tax statement) ° �, <br /> o C <br /> Permit(s)Applied for: �. <br /> Dwelling Addition y Filling/Grading Camping Unit �) <br /> z o <br /> Accessory Building Sanitary Privy Subdivision ° m <br /> Pylyall <br /> Structure Use: I U AtfutS'L�t lg' <br /> (family home/cabin, gar ,addition,4tc.) <br /> 0 <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 dralnfield (DF). 0 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 <br /> '111 <br /> Z c <br /> measurement to the ordinary high water mark of lake,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 n• <br /> dated by the owner. C <br /> PLOT PLAN3 O ( ^ J m <br /> r <br /> ;fir Q <br /> O si <br /> C' <br /> 0 <br /> P 6 r <br /> 1'� o <br /> NV <br /> o <br /> a� Jill <br /> n4 = W >. n $ m <br /> m. M w am a = >) <br /> $ < . Z uCi o 3 , <br /> C1:6 <br /> / Z o f m Q : i <br /> cc : m <br /> € O n i O <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best Of my knowl- ^ S ' m `�°�. `: m <br /> Y c <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- �;: a � O <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap. <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have ut <br /> access to the above described premises at any reasonable time for the purpose of inspection. . m g <br /> m3 A w <br /> 7g <br /> SIGN H a <br /> building contractor) (date) <br /> ZONING ADMINISTRA7;�u <br /> g HIP PERMITS MAY BE REOUIRED Q o o m <br /> 888888 $ 8ai <br />