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or\, Cool <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d 0 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and _U w <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- (D c <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 a <br /> do sof the Stat of Wisconsin. <br /> t3 <br /> vl dUE2m R NONE — y m lJ <br /> W <br /> m <br /> C 0 <br /> OW R(P�l/ease Print) 1? Contractor or Surveyor or Agent a E <br /> m <br /> Address Address <? <br /> citeta�,zipde C/ City,State,Zip Code oC' <br /> Telephone Telephone <br /> 2Me swr �2 /2►� > 0D4 <br /> Emergency) ire No. a�1d Road me <br /> 5L& 71TND.V1R) 7 /�c� ,iS,b7,oy/ab , l or / —CSM , Vol- y, Y V41 <br /> Legal Dqdcription( s indicated on tax statement) <br /> Permit(s)Applied for. � <br /> (p1 <br /> 0 <br /> New Building Sanitary FillinglGrading Camping Unit 0 ` <br /> m <br /> Addition Privy Moving Subdivision <br /> n <br /> Structure Use: /DOGE ' (a// 01AIr )i2 <br /> Z a n <br /> P v C1 <br /> (family homelc bin, garage,addition,etc.) �. <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). a <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 lake, Q �. <br /> river or stream, if applicable. <br /> S. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and dated by0 <br /> O <br /> the owner. o <br /> mill 3 <br /> PLOT PLAN N <br /> c <br /> 0 <br /> C o � <br /> J <br /> r <br /> 4 <br /> SES p lAI a G <br /> v�lF!L <br /> 0 <br /> 6r <br /> IJ <br /> � � � T <br /> ai„rw„v6- la gu�os� I�ftM °' . <br /> (�( ➢W� ^'� pf>R�/�16 N�P /9� IN p1 z <br /> W ttt <br /> wi ? so �m <br /> Z [ 1 <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of m knowl- g` '• a @ i C <br /> PP C 9 Y ) Y Y o: : Vim : p <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this infor- v' ? }n_g N p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I m v, <br /> further acce t all liabilit which ma be a result of the Count of Burnett relying on this information I am providing in this ap- <br /> plication. <br /> - a o <br /> P Y Y Y Y 9 P 9� P <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. 0 p <br /> m m m : <br /> p m <br /> SIGN HERE <br /> si ure f owner o ing contractor) (date) ' o <br /> ZONING ADMINISTRATOR <br /> HHHHrAHamq,T <br /> TOWNSHIP PERMITS MAY BE REQUIRED T ) NNOO rn <br /> m <br /> 8SSSSSBca <br />