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GR C <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> d o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and rA <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 the State of Wisconsin. // = o <br /> [� ar,zgrct [lnytahue 44 �e <br /> m <br /> c O <br /> OWNER(Please Print) Contractor or Surveyor or Agent ^ n E <br /> Slrf�n IJIcC l�g7S !Il Road � s m <br /> Address Address :? <br /> City,State,Zip Code City,State,Zip Code <br /> G "ur Fs6 SykL/ L✓r.� v <br /> Telephone Telephone 01 �. <br /> y�� ague I , <br /> Emergency/Fire�J t p <br /> No.and Road Name 1 J n pQ <br /> S f p'fl n r✓t t4/C C 01" lel,, 0 <br /> Legal Description(as indicated on tax statement) o <br /> Permit(s)Applied for: <br /> New Building XSanitary Filling/Grading Camping Unit 3 <br /> Addition Privy Moving Subdivision o <br /> t p� Z v N <br /> Structure Use: �c' r ie O f, l74/ 0 0 <br /> m <br /> (family home/cabin, garage,addition,etc.) V � <br /> O <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). o <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. aft <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. O <br /> 0111 <br /> 3 <br /> PLOT PLAN Z v <br /> M o a y <br /> m <br /> C <br /> 1 <br /> Nem <br /> m <br /> punAgW\ O <br /> CP o <br /> I � �Xls�ms m <br /> /Q�I <br /> 5 5 I\ <br /> ( I'v <br /> 9 CO fn r D D m9 <br /> acm <br /> m nm aa9 <br /> trbl 1 �C' <br /> ` =2 m <br /> Ian: G>'2 Q <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of m knowl- jc g <br /> PP ( 9 Y ) Y Y <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- p m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- X <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I r <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- ji 1.8:: <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. O^o <br /> m 3 H x' <br /> SIGN HERE 'V 0/ 0 <br /> (si atu of owner or ing contractor) (date) <br /> ZONING ADMINISTRATOR g` <br /> • ina�` in gn 7l <br /> TOWNSHIP PERMITS MAY BE REQUIRED ° N P N 2S m <br /> GggS ggy <br />