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7410 Co. Rd. K, /102 <br /> Y <br /> Siren WI 54872 <br /> Burned County Office of Zoning Administrator d -- o <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 1� w <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- mc <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 0 lSI <br /> tions of the State of Wisconsin. ^p <br /> f.., n N m <br /> J0� Den r) ZOLZ40t1s* � 0 <br /> a <br /> Triple Ple se Print) Contractor or Surveyor or Agent <br /> Address Address , <br /> x ��CaM� . ltlts S �Jg� 7 G . C, e��4 r✓5 -u�ua <br /> City,State,Zip Code City,State,Zip Code <br /> ?15 V63 ;29Y� <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit n 0 <br /> 0 <br /> Privy Subdivision 5 <br /> Structure Use: v <br /> (family homelcabin, garage, addition,etc.) o 9 <br /> m <br /> Directions for plot plan drawing: .}c <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. o <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 /> 6. Provide loyal descripbio (o toe side oF tirs For as ov tax stahe e b. n <br /> 0 <br /> PLOT PLAN 3 <br /> 'R m <br /> Z Q <br /> o a <br /> SO <br /> 0 <br /> X1 <br /> t <br /> 3 <br /> (3 <br /> ° <br /> 0 <br /> N <br /> 0 <br /> 4�5 0 q' apo+ <br /> Z <br /> I <br /> r-- <br /> �? yLekehloaot m invmmoaa.m <br /> O Q< O 'aO 2-• <br /> QI Z y : co <br /> Y o o : D2 : <br /> mno S <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <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 /> PP C 9 Yaccompanying ) g A <br /> information contained in this application includin an schedule and I further declare that I recognize that a : O <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a oo <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing m ; <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 /> SIGN HERE O "P vi. C61 <br /> (si nature of owne r b ilding contractor) �� (date) <br /> ZONING ADMINISTRATOR <br /> �i <br /> n <br /> TOWNSHIP PERMITS Y BE REQUIRED <br /> NN4 (TO N� <br /> 0 0 0 0 0 <br /> 0 0 0 0 0 0 <br /> i <br />