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of) (CM f , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m M 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> o <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- <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 Slate of consin. N p <br /> Rcyc� w�v� <br /> t'vc� u�,Uc <br /> OWNER(Please Print) Contractor or Surveyor cfr Agent n £ <br /> Addre Address <br /> l t, v�. SS�lO"1 mb\s Me\ - 5 !5 <br /> City,State,Zip Code City, State!Zip Code <br /> U t 1 - -1I 7 - '1 v r� L� Ca\,I '�a t -'1 v oG, S� <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name <br /> Lok 35 o'F Oc%rZ\j GiONt > <br /> Legal Description (as indicated on tax statement) o <br /> Permit(s)Applied for: O <br /> 0 <br /> New Building Sanitary Filling/Grading Camping Unit `- <br /> m � <br /> Addition Privy Moving Subdivision o 0 <br /> v <br /> Structure Use: CU11n'^ o 0 <br /> (family home/cabin, garage,type of 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). <br /> 2. Show the location of the well (W), septic tank(ST), and drainfield(DF). o <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 ordi- <br /> nary high water mark of lake, 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 <br /> the owner. n <br /> 0 <br /> PLOT PLAN �, a m <br /> 'Cvr� v.ro n o Z <br /> T J < <br /> O W <br /> Cs� L VNJ <br /> <� z� <br /> �c F� SEP ? 0 1989 <br /> Loy Li-Lu clIL Z e N t M <br /> © 4ccV <br /> `�1m Pd a,a- <br /> ads <br /> --� 0 a�00 <br /> n o'< 00 0 a-' <br /> l/1y \Uw m n� - amFy <br /> n— <br /> �\ SEP 81989 9 y �N 0 <br /> m <br /> - # n lo <br /> o: <br /> I declare that t is application(including any accompanying schedule)has been examined by me and to the best of my knowl- o I 0 : y <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- o m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 a <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- <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 t any reasonable time for the purpose of inspection. <br /> nn T <br /> SIGN HERE —\- I�_ <br /> (signature of ow r bui din ntrac r) (date) <br /> ZONING ADMINISTRATOR o. o <br /> o: o <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 00000 <br />