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Burnett County 7410 Co. Rd. K, #102, Siren, WI 54872 Office of Zoning Administrator U) (b) T'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;2 rn ° <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the But. - c <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 M 1 , (� <br /> tions of the State of Wisconsin. _ , OD <br /> 0 <br /> y n <br /> c b IA rL LC <br /> OWNER(Please Print) �^ <br /> Contractor or Surveyor or Agent a p 3 <br /> 99 W. coLortaoo sr <br /> Address Address �? Q <br /> sr• PAUL , MN 5510 Z <br /> CltyJ State, Ip Code City,State,Zip Code p <br /> toI z�} Co 47-6902 <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Pilling/Grading <br /> Addition <br /> Moving <br /> Sanitary <br /> Camping Unit O <br /> Privy o <br /> Subdivision o` <br /> Structure Use: UTLLtTy SHrcP IZ'-otl^_► X i$t-Ott Zt(o Ste{. r-GOT o <br /> (family home/cabin, garage,addition,etc.) z o <br /> O O <br /> Directions for plot plan drawing: � <br /> a <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. r <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, o <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. 6. Provide legal land description <br /> PLOT PLAN... w - - O <br /> P m <br /> c <br /> CTY T2UUK o n <br /> �OO� <br /> tic m �. <br /> I Cl t a <br /> IN <br /> r f <br /> N m <br /> t <br /> t <br /> 88 12 loo <br /> u, <br /> 0>0o <br /> m a m <br /> 1 p ( gT) I io <br /> Z <br /> Fb#Y 411 �fZIVE { N <br /> VJAWy I� <br /> I w) <br /> _0 <br /> ID Nvrnr DDom W <br /> t*o'r 'ro Sc.&La m �a , a m n a W <br /> mo <br /> PIKF-1KeNW4�. M&aK —Z w: dmanm3 <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my �' ` ` C <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all ° `D <br /> ng schedule)and further declare that I recognize that A <br /> information contained in this application(including any accompany! <br /> ' m <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a o <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> l <br /> ,\ <br /> m <br /> SIGN HERE <br /> (signs e f owner or ing contractor) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED MA �✓ g N o a on <br /> 0000Sooy <br /> , t <br />