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Ct1CC.c-111 ' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3_ <br /> d <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- <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. = <br /> N � <br /> OWNER (Please Print) n O <br /> Contractor or Surveyor or Agent F <br /> Address Address <br /> City, Slate,Zip Code City, State,Zip Code L)J <br /> Telephone P � Telephone <br /> 7, 7,T f/he <br /> Emergency/Fire No. and Road Name <br /> - <br /> S /r 4 t / R I f, pc y/ /�p <br /> Legal Description(as indicated on tax statement) 1)A N V vtC.y �V* J\/Z L-14- 2 (,3 L 1 Z 2 <br /> Permit(s)Applied for: <br /> a <br /> O <br /> New Building Sanitary Filling/Grading Camping Unit 0 `- <br /> Addition _Y Privy Moving Subdivision Z g o <br /> 'c r e�h /h p�%O X� A <br /> Structure Use: 0 0 <br /> (family home/cabin, garage, type of addition, <br /> Directions for plot plan drawing: � <br /> 1. Show the location and size of all existing buildings(EB) and all new buildings(NS)and indicate North (N). <br /> 2. Show the location of the well (W), septic tank(ST),and drainfield (DF). o/" <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 /,-�� ST- 3 <br /> Z c/ <br /> y <br /> t ' O <br /> J <br /> 0 <br /> f <br /> �� ✓ Q 7�Af <br /> O <br /> f � o <br /> 3a <br /> x '- <br /> 0 4 <br /> OCT 2 1989 �yr D <br /> Uu A ar' n a S <br /> D ` : � y M <br /> Z N <br /> M <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o: oJ ; y <br /> edge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all informa- o[ 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. I a <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. <br /> T ' <br /> _ m <br /> SIGN HERE 'L ZLD_;L 6t-- R9 d' <br /> (signal owner or b g contractor) (date) o o <br /> ZONING ADMINISTRATOR ` o o <br /> vi T <br /> TOWNSHIP PER ITS MAY BE REQUIRED " ^ o^ m <br /> �n vt vt vt o m <br /> 0000 Cn <br />