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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 M 0 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 y <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- a J <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. <br /> f- don Sw1&lrc,0irt it . : Artson PcOble s C4-\ txe4C _"„ N <br /> . d <br /> O <br /> OWNaa(Pl3se Pt), cContractor orurveYor or Agent <br /> +FeS f <br /> 3o 130 C". <br /> t?l N • n <br /> Address Address <br /> ��.mf)eN ( �J, . ��tyt Wabb ACL W" . 54il3D <br /> City, State,Zip Code City,State,Zip Code <br /> '`IIS - r1j& -SS31 rI)�- �� 4 - 3355 <br /> Telephone Telephone <br /> 7 <br /> Emergency/Fire No. and Road Name d <br /> -4)n-.t -tf ..3&a (�a �r7. Sore l�� t)e - MA.1" t- Lo-kc <br /> Legal Description(as indicated on tax statement) <br /> Permit(s)Applied for: O r1 <br /> 0 <br /> New Building Sanitary Filling/Grading Camping Unit w <br /> Addition _7A- Privy Moving Subdivision o <br /> 0 <br /> �f 1 /1 p a <br /> Structure Use: l�0 IpJ`i.l'-\ r `-r`0... ' ) SpO.'C-P. C� L}�0 w-`�. QUX - o -O0l <br /> (family home garage,garage,type of addition, etc.) r m <br /> c <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). <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. <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 'R N <br /> Z c <br /> 0 v <br /> a <br /> 0 <br /> C _ / a <br /> a <br /> N <br /> O <br /> r � <br /> l Imo' <br /> x (� Z <br /> � <br /> F7W Cnd am -0 <br /> o-< > > nn-. m <br /> D <br /> a< - an �s �o <br /> F Z2 O 0,0 <br /> Oo: n : <br /> o: o C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. <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 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 : 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 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 <br /> m <br /> SIGN HERE <br /> (sa hata of ow r e building contractor) (date) <br /> ZONING ADMINISTRAT U o o <br /> Q i d T <br /> N N O V N m <br /> TOWNSHIP PERMITS MAY BE REQUIREDm <br /> 00000' o <br /> 00000 otn <br /> (J <br /> V{ <br /> O <br /> 0 <br />