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C11 l Y )'1 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m - o o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> s <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 <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- <br /> tions oft Lthe State of Wisconsin. = p <br /> �dlrSef 77 <br /> A <br /> N d <br /> C v <br /> OWNER e Print) Contractor or Surveyor or Agent n E <br /> �� v(Pleasst C►r�l>< �* N <br /> Address Address <br /> �[�Jry UJIs _ .syo/(o N <br /> City,Slate,Zip Code City,State,Zip Code <br /> Telephone Telephone <br /> �l�-386 -598'y s <br /> Emergency/Fire No.and Road Name <br /> U/-ivAI- 4t,,-r <br /> Legal Description(as Indicated on tax statement) o (� <br /> Permit(s)Applied for. <br /> New Building Sanitary Filling/Grading Camping Unit 0 <br /> Addition Privy Moving Subdivision c o <br /> �o C— az� s��b is ycSh 7�© °` <br /> Structure Use: • P `0 <br /> (family home/cabin,garage,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 drainfleld(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. '1t <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, 0 <br /> river or stream, If applicable. 9 <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and dated by O <br /> Z <br /> the owner. <br /> PLOT PLAN v w <br /> t/.9. ow �A16f �1 Q <br /> d C) n <br /> m �L s <br /> O C <br /> t � a <br /> 40 <br /> a <br /> rJe-01� <br /> 5)e ��'�t oN Etfs�l� fnab.4 Ik� _ <br /> G <br /> F� Sln6 c <br /> too <br /> (IL <br /> � c <br /> ao) <br /> L <br /> 8 <br /> m <br /> e $� —nm sn7o <br /> CfAoS <br /> 'n ; <br /> 3 Z o : <br /> o , s <br /> Cor ' =M S21 71 <br /> g: : m <br /> PP (including Yaccompanying ) Y Y <br /> 1 declare that this application Includin an schedule has been examined b me and to the best of m knowl- o. 9 <br /> edge and belief it Is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa• : m <br /> tion contained in this application(Including any accompanying schedule)and I further declare that 1 recognize that this Infor• i i i : a <br /> mation I am providing will be relied upon by the County of Bumett Wisconsin in determining whether to Issue a permit. I v,E <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 at any reaso le time for the purpo dtion. p <br /> m m : <br /> m ' axi <br /> SIGN HERE X S -�S�eId " L i <br /> (sl ueDf dy o,ptuildingcontractor) (date) 3 0 g <br /> ZONING ADMINISTRATOR <br /> MM NNMH}•±�I <br /> TOWNSHIP PlEeRMITS MAY BE REQUIRED a N n o 075 m <br /> 8888888th <br />