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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 c5� Cc l <br /> Office of Zoning Administrator rn -0 1 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 W <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 a <br /> Bur- <br /> tions pf the State of y�(isconsin. _ <br /> OWNER(Please Print) -'-` r r"� '�- � c <br /> �� 6nosQ-iin.� S� Contra or or Surve r or/}gent <br /> Ad cess / o /6 F <br /> m W <br /> �- � Address m i <br /> V� / i✓ N <br /> Cit//y State,Zip Code City, State,Zip Code <br /> Telephone <br /> Telephone C <br /> Emergency/Fire No. and Road Name <br /> kOT X20 . Sr//sal. <br /> Legal DescArk S Ind,uso 3 l 37 �y <br /> nptlon (as indicated tax statement) C <br /> Permit(s)Applied for ! o <br /> rt <br /> New Building X SanitaryFilling/Grading O 0 <br /> Fillin I <br /> 9 9 Camping Unit o < <br /> Addition Privy <br /> X r4loMovni � Subdivision <br /> Structure Use: CALC !2 4.1 o�� � W »� <br /> ��� d v <br /> V (family home/cabin, garage, type of addition, tc.) <br /> a <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 (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. r <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 O <br /> nary high water mark of lake, river or stream, if applicable. r <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. , <br /> PLOT PLAN 3 <br /> o e Q <br /> y a <br /> f by -._.___ f O <br /> � —-- "C F' <br /> - cr a <br /> All <br /> Q r <br /> - _ AN a <br /> OXdC <br /> Is �f° 3 <br /> Rtc r j <br /> �I01 <br /> v » <br /> b� <br /> --------------------- q FIA e.--ra <br /> Us;� 30 `rowAj <br /> R1�•� J wr atcc�_ bC krA-y <br /> a m <br /> LD. O. c n m a a S <br /> mcW - - 3 <br /> -. Z W `� O =10 - <br /> _ <br /> S7/'/&,N OCe ____-- - z O i N Q : : -4 <br /> N: m <br /> �: <br /> ID <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o a: <br /> �O'ai <br /> eC <br /> edge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all informal- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i `ao i <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- W <br /> plication. I agree to permit county officials charged w' h administering county Ordinances or other authorized person to have <br /> access to the above described premises at any real -able time for the purpose of inspection. <br /> -n <br /> SIGN HERE _ ���— � � v 0 <br /> r <br /> (s' n u of owner o`p ilding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> o:m: o <br /> TOWNSHIP PERMITS MAY BE REQUIRED NN TNOOP m <br /> n C / C I Q )cti N O V ?S <br /> �e�n�d lrlOAr§ <br /> 0_1;7 <br /> 1"erm r� ; PXdose4 Jc,/ Oru �f-e SJe. o l'�'14 rC1 .e Ooco$od+ CAI <br /> be- Sec-ded - rP'tk,hJ- A Vnechat'A <br />