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dobe � 1'nar�ua{ot� Com' � C�✓1 �° <br /> Arnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator iu � 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 0 <br /> TO 14 ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and -V 0 <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 n <br /> tions of the State of Wisconsin. <br /> �✓/!U/O C vnis�r�r c�csu�i S��r = o <br /> O/yJ�N ER(Please Print) Contractor or Surveyor or Agent n f <br /> m <br /> Address Address <br /> Sz- '7tD 1 <br /> City,State,Zip Code City, State, Zip Code 1 <br /> -7/s - 7SS ' 35U Z 9J I G <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name L 4 ' p <br /> Legal Description (as indicated on tax statement) fV6 y. ,j,/c2J / o O <br /> Permit(s)Applied for: S4>SSS <br /> O <br /> New Building Sanitary 3FillinglGrading Camping Unit m <br /> � <br /> Addition Privy Moving Subdivision o .or. <br /> F - C�toi� 2L S i Tht/ SSI/SjP�/ o o <br /> Structure Use: <br /> (family homelcabin, garage, type of addition, c.) } Lp <br /> Directions for plot plan drawing: Di <br /> 1. Show the location and size of all existing buildings(EB) and all new buildings(NB)and indicate North (N). ,N <br /> 2.Show the location of the well (W), septic tank(ST), and drainfield (DF). V 1 r <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 w <br /> the owner. 0 <br /> 3 <br /> 3 <br /> PLOT PLAN /U _W ('Qytpjt /p$;; P m <br /> 83SFj30 {� C3rq u 3 Deer A a <br /> whi, L�lb, m / F//cam ND 39// �� I <br /> jr <br /> b 1 <br /> •w p ILI YF 4"+4 �l � � <br /> v o <br /> a � � <br /> Z <br /> CoNGu�t� a� Pe�M�-f-,1 l <br /> Qusi oti 11 - -�`( �o.� S F6n�ks to SuB es 0t- <br /> 5 � to be m4f- t�.�(A v �d cJp3 l �� �CJ <br /> ca�11 NOV 1 61989 i' I i a 0 <br /> UU < : N O <br /> w : O <br /> /99d Z <br /> .2GvGat� Q t'n: � c ! m <br /> o C <br /> I declare that this applica i n(i cluding any accompanying schedule)has been examined by me and to the best of my knowl- 0 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- 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 <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 /> a <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 /> T <br /> N <br /> SIGN HERE <br /> ( g ture of o or building contractor) (date) <br /> ZONING ADMINISTRATOR o: o <br /> T <br /> c, <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 000� N <br />