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Burnett County 7410,Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 0 <br /> USE — PERMITS 0 <br /> APPLICATION FOR — LAND 3. <br /> N <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur-- 3 a <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula0 <br /> tions of the State of Wisclonggsin��yy�� m w <br /> o <br /> a � <br /> OW R (PI ase Print) Contractor or Surveyor or Agent o <br /> Add aQyl d <br /> s Address r.. <br /> City St <br /> Stat Zip Code City, State,Zip Code <br /> Telephone Telephone t <br /> yak La Ke �a� <br /> Emergency/Fire No. and Road Name <br /> 0 <br /> Legal Description (as indicated on tax statement) <br /> Permit(s)Applied for: o O <br /> o <br /> New Building Sanitary Filling/Grading Camping Unit' <br /> m r <br /> Addition Privy Moving Subdivision o 0 <br /> SA' aJ. �tJ�� C Dfl c�. L[� �' 0 <br /> Z O <br /> Structure Use: ci' m <br /> (family)home/cabin, garage,type of addition, etc.) <br /> O ` � <br /> Directions for plot plan drawing: p0-1 <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 drainfield (DF). <br /> 3.Show the location of any lake or flowage-if within 1000 fl. 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 ordi- <br /> nary high water mark of lake, 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 O J <br /> the owner. ��j o—� <br /> 3 <br /> PLOT PLAN o <br /> 1 <br /> (D ZIA <br /> a <br /> o <br /> 0 <br /> �0 , lO <br /> N <br /> --- � <br /> Z <br /> m cmay. 0aCm <br /> B.S. <br /> o 0 3 <br /> N Z Ey 2 7 D <br /> _ N: M <br /> o: C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o I E [ <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- �-' ` o' <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <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. m <br /> m <br /> j <br /> SIGN HERE <br /> (signs a of owner or pgildi contracto^r)�, I (dat ) o; o <br /> ILF}I��i OI�IIV o: E o <br /> ZONING ADMINISTRATOR [ ' <br /> �rNoi�. 000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED $gob <br /> o 0 0 o y <br />