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�7 LIQ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3. 0 -- <br /> 0 <br /> TO THII 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 m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> reulations/of the State of Wisconsin. H m <br /> t5Ak' 4lep A. <br /> OWNER (Please P - t) Contractor or Surveyor or Agent m <br /> tic 6 U g' , 7� <br /> A es Address <br /> City, Ste e,Zip Code City,State, Zip Code <br /> l JLS `79rI <br /> Telephone Telephone <br /> �m Sgenc tre ohan�poad Name Q,717Z11/A / ��/ , y� i5 l-36 1,W0� o <br /> Legal Des ptioLo(Cas indicated on tax statement) ,/6 LNT- '.,jd m rnoAl 6* <br /> Permit(s) Applied for: 0 <br /> ✓ cock <br /> Dwelling Addition Filling/Grading Camping Unit S <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision P } <br /> Garage <br /> ll � <br /> Structure Use: l� f A1 - 5 <br /> (family home/cabin, garage, addition, etc.) �. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: C <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). M <br /> 2. Show the location of the well (W) septic tank (ST),and drainfield (DF). 3 <br /> 3. Show the location of any lake or flowage-if within 1000 ft. and the location of any river or stream- if within <br /> 300 ft. o n <br /> 4. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)buildingm f y <br /> W <br /> to lake, river or stream, if applicable. Y <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and a <br /> dated by the owner. <br /> 11111 <br /> / 1 <br /> PLOT PLAN �Q4'tif fed <br /> L�K��� �PSo��enl ir✓� Cmc'-�s'vc . -� � I <br /> j ; 2 <br /> / J- <br /> 0 Illr_so,7 <br /> r n <br /> a � r s� <br /> CJQi t �I �Y z <br /> �// � U) N � (nrD ➢ O 11 <br /> o. c m m n m. f m <br /> 04. <br /> m o 00 '0 3 <br /> ( Z m o <br /> m <br /> C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- S m `� m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- w m to O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- b"m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g m 8 <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- N <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O �„ o <br /> access to the above described premises at anyreasonable time for the purpose of inspection. : m 8 m <br /> m 3 ^ O <br /> N A m I <br /> N m <br /> SIGN HERE gn ture of o r uilding contractor) (date) o , <br /> ZONING ADMINISTRATOR <br /> N N O Nis <br /> m <br /> TOWNSHI PERMITS MAY BE REQUIRED v N N <br /> 88888ami <br />