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( -�_ <br /> Burnett County 7410 Co. Rd. Kr #1029 Siren, MI 54872 Office of Zoning Administrator � l ; o m ' o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> 3 � <br /> TO THE ZQNMG ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 'z y <br /> located as shoW-n herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- <br /> 0 c <br /> nett,Cqunty Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 n <br /> tio�ngqs of the State of Wis/consiin... i � // o <br /> 'V C-i_V_ L._r 1 f 091 £ ` �1GiY!� t;l`1Ici !� f c 94, V- C = � <br /> O NER(Please Print) Contractor or Surve or or Agent n O <br /> 705 Sn r�l� i� F� f <br /> Addres Add ess <br /> 1=.s4e_r . W� 5Y893 LeSttie(AVr I✓(N <br /> City,State,Zip Code City,State,Zip Code <br /> 715 - 8ro�-7115 i,la.-- /8�,5- ��b3 ' 1'I <br /> Telephone Telephone VV <br /> Permit(s)Applied for: a <br /> New Building Filling/Grading <br /> Addition Moving o t <br /> Sanitary Camping Unit y1 <br /> 0 <br /> Privy Subdivision m <br /> 0 <br /> Structure Use: ��r✓i.i 'V .to Plil � <br /> (family hometcabin,garage,addition, etc.) o a <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). f`; <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. Vi 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, <br /> river or stream, if applicable. (,4 <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. 6. Provide legal land description. o <br /> PLOT PLAN o <br /> 3 <br /> 'R y <br /> Z <br /> o n <br /> lea a <br /> N <br /> o "•i <br /> /2S 40 -� D�`` <br /> f � t , GIN <br /> N <br /> Ila u �o <br /> for ti <br /> �I.--- <br /> T <br /> o � <br /> ` Z <br /> l <br /> v m r a <br /> D ID <br /> d m nn_ m <br /> am <br /> ,:nom <br /> v 5 ' °1 cu, o93 <br /> Y_3 <br /> i <br /> 2 S <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of E <br /> PP ( 9 Y ) Y o; m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all 6 a ym <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that N A ; O <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a o <br /> permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am providing <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized a <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. f <br /> SIGN HERE - `\ <br /> (si at re of own r building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PE Mtnm <br /> ITS MAY BE REQUIRED N N N T <br /> vt u,rnoo <br />