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�1Y�/I _inf y� / <br /> �. � <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3' <br /> w 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m S <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- <br /> tions of the State of Wisconsin. o <br /> N d <br /> L�cuC-44 Lir y <br /> OWNER(Please Print) ZAdd <br /> ctor or Surveyor or Agent n £ <br /> X3000 S' . d _ <br /> m <br /> Address ss <br /> City,State,Zip Code tate,Zi - <br /> -a � I <br /> 'Telep one one cEmergency/Fire No. and Road Name itLegal Description(as indicated on tax statement)Permit(s)Applied for: 0 <br /> New Building � Sanitary YGrading ping Unit m <br /> r <br /> Addition Privy Moving J Subdivision o 0 <br /> Structure Use: ev� d � ' f`� �u4�rr� 0 0 <br /> (family home/cab'n, garag , type of addition, etc.) <br /> U! <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). h <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. (}.) 0i <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. o <br /> 3 <br /> PLOT PLAN <br /> e" <br /> �° `/� <br /> & � Per , rf lo , Dec K T <br /> C' <br /> cUccr � � R5 <br /> tl� <br /> C) o� ,r P <br /> f> 1 -7 1 <br /> 0 <br /> _ <br /> f7 O - <br /> p �Z <br /> t Z <br /> )0 r <br /> v <br /> NOV131989 0 m <br /> m c 0 <br /> n <br /> N N O = <br /> Z 0 O = <br /> O 3 i <br /> Com: p <br /> 0 i C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- i 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 n E ': <br /> further accept all liability whiphmay 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 /> m i <br /> SIGN HERE ;;i <br /> /- ✓ (signature of owner orbuilding contractor) (date) o o F <br /> ZONING ADMINISTRATORY)CS�. <br /> � ooNm <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 00 o c o m <br /> .00000 U! <br />