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715-349-2138 tJ f 1 L ci l l r <br /> Burnett County 7410 Co. Rd. K, #102, Siren, WI 54872 Office of Zoning Administrator m v Z <br /> APPLICATION FOR — LAND USE — PERMITS m 3. <br /> ° 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 'Z 6 <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 a State of Wisconsin. - <br /> r N pl <br /> OWNEA�( ase,Pri n O <br /> ��--ff Contractor or Surveyor or Agent o 0 <br /> Ady.sg 1 <br /> f Address <br /> V ,ley <br /> City,State(,Zip Code n City,Slate,Zip Code <br /> Tele hone f <br /> P Telephone ; <br /> Permit(s)Applied for. <br /> New Building Filling/Grading (�y <br /> Addition Moving v C � � <br /> Sanitary Camping Unit �_ O <br /> Privy Subdivision o <br /> Structure Use: pk ,• o <br /> (family home/cabin,garage,addition,etc.) o o <br /> a <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 drainfleld(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. Provide legal land description. <br /> n <br /> PLOT PLAN /�(//� {(,��I}(`/1 I �I/ ° <br /> <. <br /> t <br /> A <br /> l J <br /> Vol <br /> I et� <br /> Z <br /> ° <br /> Z <br /> yi <br /> ( <br /> s� p <br /> J J G O z wv rn r DR S.M <br /> (AJoie <br /> m c _.m w o a c m <br /> C N <br /> s tA,f, 1995. ecf W"d :P� 19(c <br /> 91.15A� Z ? ? N <br /> ° o : : :0 <br /> IM <br /> 0 <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 ° ` ° ` ' <br /> information contained inA s a lication includin an accom an in schedule and I further declare that I recognize that ` A : ! p <br /> PP C 9 Y accompanying 9 ) > <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a <br /> permit.I further accept all I ability which may be a result f he County of Burnett relying on this information I am providing g E <br /> in this application. I-sgreq to permit county of9cTals c ed with administering county ordinances or other authorized <br /> person to have accgss o the a described/Or t any reasonable time for the purpose of inspgotion. <br /> SIGN HERE '� """f r� <br /> -Oiibnatkf of owner b ding contractor) (da ) E ': <br /> o: <br /> ZONING ADMINISTRATOR e c <br /> TOWNSHIP PERMITS MAY BE REQUIRED NNTN°NO <br /> 88888' <br />