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7410 Co. Rd. K, #102 <br /> Siren, NI 54972 <br /> Burnet# County Office of Zoning Administrator C 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3' <br /> m O <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- 91 <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- <br /> tions of the State of Wisconsin. m o �- <br /> rzoa1 <br /> OWNER(�TPlease Print) Contractor or Surveyor or Agent o <br /> � oSavnES <br /> Address Address ` <br /> �7- u_1 <br /> r <br /> City, <br /> 4 cola) fo!37- a`7/State,Zip Code City, State,Zip Code <br /> a- <br /> elephone Telephone <br /> Permit(s)Applied for: vvv <br /> New Building Filling/Grading <br /> Addition Moving v <br /> Sanitary Camping Unit o ry <br /> Privy Subdivision N <br /> AL 0 <br /> Structure Use: uif-6 I 'D <br /> (family home/cabin,garage, addition, etc.) o o <br /> a <br /> m <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). <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 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, <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 <br /> the owner. 0 <br /> 6pL v� e e—gal description on the side of thisform) as on tax statement. O <br /> a N <br /> c <br /> Z a <br /> o n <br /> N <br /> O <br /> I > <br /> T' <br /> P <br /> u � <br /> \l 1 <br /> t a <br /> N <br /> m <br /> f� O <br /> ya N { 1 1 <br /> V O <br /> > <br /> > <br /> O <br /> m L <br /> Z <br /> ��y n O <br /> 3) <br /> 50 Ff� n ceCT proykwnj, <br /> P7-f-(J�4L F£FT FRDYn 5���2G -F �2A�A( ZEL0. <br /> m c=wm 0 acm <br /> m o•< > > mn-� <br /> am �aw <br /> a "Cmo5'3 <br /> w Z o >o <br /> N: m <br /> . J <br /> o <br /> I declare that this applicat on (including any accompanying schedule) has been examined by me and to the best of my S: im <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all pj= ; A m <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a o <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing a <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m E <br /> m <br /> SIGN HERE <br /> (si nature of owner or building contractor) ((Ate) <br /> ZONING ADMINISTRATOR E i <br /> TOWNSHIP PERMITS MAY BE REQUIRED U ti NNO <br /> �000000 <br /> 00000 <br />