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of� cc) IP- <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d _ 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3, <br /> d a <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 0 W <br /> nett Couhty Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 a <br /> tions of the State of Wisconsin. p <br /> I_ Le V J NFIJMnNN JAMES NaLT y <br /> a O <br /> OWNER(Please Print) Contractor or Surveyor or Agent f <br /> Liffo5 <br /> Address Address <br /> tZnUTE��_�$.3G <br /> CityTSt�ate,Zi'p Code City,State,Zi Code <br /> DA Alrl I��, WisGoNS ctf. !P I � �- yro/O � 1 <br /> Telephone Telephone <br /> EmergencylFire No. and Road Name ,J (� <br /> Legal Description(as indicated on tax statement) Araziseon S 5M 1/ a PALI o <br /> CLocatrd If Lot 3 <br /> Permit(s)Applied for: jr n 0 <br /> New Building Sanitary Filling/Grading Camping Unit 0 <br /> N <br /> Addition Privy Moving Subdivision g <br /> ee n <br /> Structure Use: � �a x i � o � (> <br /> (f it home/cabin, garage,addition,etc.) r.(� <br /> i <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). (n <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. an <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, C <br /> river or stream, if applicable. X <br /> 5. If,separate plans are Submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and dated by 0 0 <br /> the owner. <br /> 11a m <br /> PLOT PLAN <br /> o <br /> C d' <br /> f, <br /> VV N <br /> 0 $ <br /> Or, to <br /> 63, T f�4 <br /> cel,fe, b-e_ o <br /> TOWA/Poci. (6 rb C <br /> i <br /> Po ?cfFt I6 )5,1� r� N� <br /> �. <br /> -- 70 COM g C 11 0 A•®y <br /> (03 t —m <br /> _ i£� ..am� �'aa <br /> dao �m <br /> e heir { ° <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- $ €g; ? g'm 9 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- 1r:=i : m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 0`. '• ' iw g p <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- I $� <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..p <br /> A 3 H Ow <br /> 'N HERE— a I b1�' N i i <br /> (/ (signal of owner or buicontractor) (date) <br /> g <br /> u . <br /> `MINISTRATOR <br /> �NNO N�H m <br /> TOWNSHIP PERMITS MAY BE REQUIRED a nv u oom <br /> QS$$$$$$N <br />