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a),-A (�c -) P <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator cm o 0 <br /> APPLICATION FOR — LAND USE — PERMITS d 3- <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and uNi <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m m <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 a <br /> tions of the State of Wisconsin. o <br /> m O <br /> OWNE (Please Print) Contractor or Surveyor or Agent a £ <br /> ,3751 Lavl.I ICO. o <br /> Address Address <br /> ,Of/'t/l?4Lc R Wi S , S"y Fra O <br /> City,State,Zip Code City, State,Zip Code <br /> Telephone Telephone ^ <br /> Emergency/Fire No.and Road Name <br /> Legal Description(as Indicated on tax statement) v <br /> Permit(s)Applied for. n o <br /> New Building Sanitary Filling/Grading Camping Unit <br /> Addition Privy Moving Subdivision <br /> v <br /> Structure Use: C A Qlill <br /> (family home/cabin,garage,addition,etc.) <br /> Directions for plot plan drawing: <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 we#(W),septic tank(ST),and drainfield(DF). <br /> 3. Show the location of any lake or flowage-if within 1000 ft.and the location of any river or stream-If within 300 ft. <br /> 4. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building to lake, 0 <br /> river or stream, if applicable. <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and dated by 0 <br /> 0 <br /> the owner. m <br /> �f v e] <br /> PLOT PLANZ <br /> a <br /> L 601,/ L 9k �` i2 D, 3 7s! M .O <br /> `� <br /> WELL I'N3h515AIrM � � <br /> FIGU .SGO <br /> gi L <br /> TN /X95 l 6 F 6u- �a/N <br /> '611( <br /> /-2s— F�erT SaGT <br /> h/ OF6' u , LDini6- <br /> _ <br /> 0 <br /> 75 U D , , CFtS orLo7 t s <br /> r " <br /> i n/.c <br /> W<s T O p <br /> C <br /> r fo <br /> o <br /> o <br /> m <br /> � <br /> X3 �-� � ��lne i <br /> r <br /> see ��i�/7 X35of IVi <br /> ... 9 N�fprDDWy <br /> m c �.mmmacm <br /> iD i€� �am aaA <br /> v < p1Cao�; <br /> Z tli Zmo �m � <br /> € �2 3 m <br /> 8 C c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- S: <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- C)= m <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 will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 <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. E 0 <br /> SIGN HEREN- <br /> (s' 1ere of owner or ing contractor) (date) <br /> 8i <br /> ZONING ADMINISTRATO ' <br /> `p�l��rAH <br /> TOWNSHIP PER19 TS MAY BE REQUIRED <br /> �-jn fTNfNTO <br /> S000$ N <br />