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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m --0 <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 H <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c L <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 0. <br /> regulations of the State of Wisconsin. m o , <br /> N � <br /> C <br /> 6 <br /> ER (Please Prins}.- Contractor or Surveyor or Agent o m' <br /> Address tx <br /> Address <br /> 2 60 1%7Z/&2& �eD <br /> City State, Zip Code City,State,Zip Code G <br /> 1�rr'eX'T; �f/'s. ��30 <br /> Telephone Telephone <br /> 2 - -7 <br /> Emergency/Fire No. and oad Name <br /> `j lo,,an <br /> i7[MeLL /-ZQ n <br /> Legal Description (as indicated on tax statement) r Zs- 'V <br /> spa. �s �/. Oz7oo Cor z/ cs V �� �/C/u 9ovr Zor <br /> Permits)Applied for: o <br /> m r <br /> Dwelling Addition Filling/Grading Camping Unit o ° <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision o <br /> Garage /I <br /> Structure Use: �. .a�E r <br /> 0 <br /> (family home/cabin, garage, addition, etc.) � � \ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: 0 J <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). 0 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 P <br /> 300 ft. a n <br /> 4. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building 0 <br /> to lake, river or stream, if applicable. M o <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. (A <br /> PLOT PLAN -- 3 <br /> ,A/ <br /> ) <br /> J m <br /> n <br /> 0 <br /> � o <br /> L � � <br /> /PKC o <br /> .m. ~ <br /> -° O <br /> \ 3° o yti <br /> t �\ <br /> o_m '.0 (.0 g m <br /> . mm o0- m <br /> CO H so <br /> < m' : Z N <br /> P A m I <br /> Ip <br /> M <br /> O O . <br /> f TN: m <br /> m <br /> N eco [ O <br /> 8 c : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- S m I m <br /> 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- <br /> mation I am providing wi I be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 8 m g <br /> further accept all liabili hich may be a result of the County of Burnett relying on this information I am providing in this ap- y, <br /> plication. I agree top mi county officials charged with administering county ordinances or other authorized person to have <br /> access Ic the above es ribs ises at any reasonable time for the purpose of inspection. m g m <br /> SIGN HERE F^ <br /> to f owner orb ng contractor) (date) v ; <br /> o : x : <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMI S MAY BE REQUIRED N N N U N O O 88 m <br /> 88 $ 88 $ 8 $ rmn <br />