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' 11 ( O fn _P, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ',�', _0 o 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 v m <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- N <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 <br /> doryg of the State of Wisconsin. f /� ( \ <br /> { p C <br /> ` O hrtSF k) SP `/ l �l��fry SCVy4 <br /> n Ln O <br /> OWNE(PI�spPrint) Contractor or Surveyor or hent LA' nn £ <br /> Address — Address <br /> City,St te,Zip Code City,State,Zip Code i /I <br /> DAMNRi (til <br /> Telephone Telephone ^� <br /> 00 <br /> EmergencylFire No. and Road Name I G G <br /> Legal Description(as indicated on tax statement) o n <br /> Permit(s)Applied for: m <br /> New Building Sanitary n Filling/Grading Camping Unit 3 <br /> 4i <br /> Addition Privy Moving Subdivision g <br /> Structure Use: FO-r�� g %t'_ o <br /> 0 <br /> (family home/cabin, garage, type of addition,etc.) m <br /> J � <br /> Directions for plot plan drawing: <br /> (! <br /> 1. Show the location and size of all existing buildings(EB) and all new buildings(NB)and indicate North (N). +j <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. i,l <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- V" <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. 0 <br /> O <br /> PLOT PLAN <br /> NfaC - rloC4A4�} i v b Cie v tP i o L� <br /> JI <br /> ReiUrtiaf �CJbe P" C(� © � AJ <br /> y <br /> d3oJIDn - DViiVe-u)ty ineejSO4,4QNe IOii <br /> CD `m <br /> nl ` <br /> ) <br /> o <br /> R.aid <br /> r K u.Yt( <br /> ,I �� — o • !d° 3 rui <br /> CMmm �a� v <br /> o acOno oa-. m <br /> dao <br /> c:Noy ; <br /> N N O 7(O <br /> CSN: G <br /> o: . <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- O o_ <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 an accompanyingschedule and I further declare that I recognize that this infor- <br /> mation <br /> V <br /> PP C 9 Y ) 9 <br /> I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 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 chargedwith ad istering county ordinances or other authorized person to have - <br /> access to the escribed pre es at any reasons a tiTe for the purpose of inspection. <br /> SIGN HER ke' <br /> (signature of owner or building contractor) (date) /n� <br /> O: : O <br /> ZONING ADMINISTRATOR S <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> -90 <br />