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Oq <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator c <br /> C o Z <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 'z m <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m c o <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. m <br /> Edward E. DUFresne , IL <br /> o <br /> OWN (Please Print) !_ <br /> � �h t�,Jap 1 Caorltr for orvEvor Agent a O <br /> F <br /> Address(� � m <br /> SI)(YPllll�'!11 <br /> City,State,Zip Code 11��'� ` <br /> City,State,Zip Code <br /> T <br /> e <br /> le <br /> ph ne <br /> 2909 Cranberry Lk. DR. Telephone <br /> Emergency/Fire No.and Road Name ..� <br /> Legal Description(as indicated on tax statement) <br /> Permit(s)Applied for: p <br /> New Building Sanitary T <br /> Filling/Grading Camping Unito` < <br /> Addition y <br /> Pm Moving Subdivision `" o <br /> a' t'l(4ti'11 S f <br /> Structure Use: o <br /> Z/,i r �« v <br /> (fa ily home/cabin,garage,addition,etc.) P c <br /> m <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 M/), septic tank(ST),and drainfield(DF). 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. o <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, 1 t <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 0 <br /> the owner. <br /> PLorPu1NHistory 35-16 420/82 �� � 0 <br /> S35/T41/R16 W Acres 340 m <br /> PCL/# 41. 16. 35. 03500 - \ <br /> LOT 3 CSIDI V 1 P 56 & PCL LOT �n c <br /> 1 CSM V 1 P 51 DES IN V 213 x/ Cy I <br /> P 240 EX V 237 P 8 M � <br /> 0 <br /> lam/ c <br /> t <br /> ZS N <br /> f . <br /> STwr. <br /> ( <br /> h i � <br /> mCoo' <br /> Q 08 <br /> Z-1 A Mc <br /> �€ m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- E n: - C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- 8. <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation <br /> o . ` n". m <br /> mat er I accept <br /> providing will is relied upon s the County of Burnett Wisconsin in determining whether to issue a permit. 1 $ �, <br /> further accept all liability which may be a result a the County of Burnett relying on this information I am providing in this ap- i ga N: <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 : (7»pi <br /> SIGN HERE Im i H x i <br /> (at at re of owner or ilding contractor) ' ±o'y <br /> p' <br /> p: <br /> i <br /> ZONING ADMINISTRATOR (date) <br /> 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> NucNn000m <br /> 888888 <br /> PIZca <br />