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7410 Co. Rd. K, #102 <br /> Siren, M7 54872 <br /> lauriza@t County Office of Zoning Administrator N 1 Z <br /> APPLICATION FOR — LAND USE — PERMITS 3 F ° <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and '; y 0 <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m c ^ <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. <br /> ���Ue/✓ �IDNe�t Ohsc9� 52� � _ � <br /> m <br /> OWNER(Please Print Contractor or Surveyor or Agent n <br /> Address Address <br /> �a urn 6J, <br /> City,State, ip C�3p� City,State,Zip Code \t, <br /> Telephone Telephone b <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving o O <br /> Sanitary Camping Unit $ G) <br /> o <br /> Privy Subdivision ° <br /> /� " r <br /> Structure Use: 3 ,SeC(zSOn/ O '/00 � <br /> (family home/cabin,garage, addition,etc.) o 'o <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). O <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. <br /> n <br /> PLOT PLAN o zsterm) as on tax statement. <br /> 3 <br /> 9 m <br /> Z a <br /> G Tr� <br /> LczF 330 I Y <br /> s <br /> m <br /> 0 <br /> N � <br /> � O <br /> N <br /> Z <br /> O <br /> Z <br /> (a � <br /> m c n ac�� <br /> n as > > n a-.m <br /> m n� - am ^:nom <br /> a 5 "c0, .0 3 <br /> y 2 � n <br /> z <br /> 0 : <br /> o � <br /> rn <br /> O <br /> I declare that this application (includingan accompanyingschedule has been examined b me and to the best of m ' o c C <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all ; m <br /> information contained in this application(including an accompanyingschedule and I further declare that I recognize that <br /> PP (� 9 Y ) 9 <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a Ao <br /> permit.1 further accept all liability which may be a result of the County of Burnett relying on this information I am providing <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized a <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> N <br /> /X SIGN HERE <br /> (sign ure f owner or buil �gg contractor) (date) <br /> ZONING ADMINISTRATOR <br /> ' NNON N <br /> TOWNSHIP PERMITS Y BE REQUIRED Cv,v,u,u -nm <br /> 0000 o fn <br />