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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator W M0 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and y <br /> 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 /> Robert L Belden L.D. Duncan Const. <br /> OWNER(Please Print) Contractor or Surveyor or Agent o. O <br /> 24996 Leghorn Dr. Box 284 (� <br /> Address <br /> Address m � � <br /> Siren Wia. 54872 Webster Wis . 54893 <br /> City, State,Zip Code City, State,Zip Code <br /> 715-866-897 715-866-14751 <br /> Telephone Telephone <br /> 24996 Leghlamn Dr. Meepon Township <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as indicated on tax statement) <br /> Permit(s)Applied for: o <br /> 'm L7 <br /> New Building X Sanitary Filling/Grading Camping Unit 0 < <br /> L <br /> Addition Priv ,f m <br /> Privy L� X Moving �� -� Subdivision 6 a <br /> Structure Use: ('a o (� 7� A <br /> Z ; <br /> (family home/cabin, garage, t of addition, etc.) <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 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 <br /> the owner. <br /> O <br /> PLOT PLAN O <br /> 3 <br /> D <br /> Z coc <br /> O O' <br /> n <br /> 5 <br /> 0 <br /> Al c>r tll !n <br /> W <br /> Fr <br /> it <br /> 11 ~ m <br /> ti 0 <br /> 411:� o <br /> i v L! ly 0 <br /> V <br /> Alf SO S $� <br /> QQ n O <br /> N � <br /> - <br /> V ' � L. / a� <br /> a c I z <br /> F <br /> my Wr DDW � <br /> c,<'> > 0a m <br /> 0'n om <br /> o w" X003(993 <br /> 0 o'E E mZ : -i <br /> 0, <br /> u,: [ E - D <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know]- 0 0 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- ° C <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 0 p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I n <br /> further accept all liability which may be a result of the County of Burnett relying on this information I amrovidin li L <br /> plication.I agree to permit county officials charged with administering county ordinances or other authored person toha e <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> 1--771 <br /> f m <br /> SIGN HERE <br /> (s a ure of owner or ing contractor) (date) <br /> ZONING ADMINISTRATOR � ?: <br /> o: c <br /> o: o <br /> T <br /> TOWNSHIP PERMI S MAY BE REQUIRED N N O N <br /> UNV'N OO <br /> 0 0 0 0 0 0 <br />