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Burnett County 7410 Co. Rd. K, #102, Siren, WI 54872 Office of Zoning Administrator C0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 _ - <br /> ;u o <br /> TO THr 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- 3 n -.`.1 <br /> tions of the State of Wisconsin. v <br /> N d <br /> m <br /> -rh,o m AS l -/E'/S Ink � <br /> /J s 0 O <br /> OWNER(Please Print) V Contractor or Surveyor or Agent o <br /> 77Nk <br /> apn�pddress Address v > <br /> LJ ren L N In PARK n1 n ,TSYY3 <br /> City,State,Zip,Code City,State,Zip Code ''�<1 ° <br /> (tel X60 —05-6S� <br /> Telephone Telephone <br /> r n <br /> Permit(s)Applied for: .r, <br /> 14 <br /> New Building Filling/Grading �- <br /> Addition Moving o <br /> Sanitary Ar Camping Unitn o <br /> 4 <br /> Privy Subdivision 0 <br /> -t Ir �A101tJ lFAmt[ ti� �A1Ur l � !!;� fy) <br /> Structure Use: <br /> (family home/cabin,garage, addition, a c.) o 0 <br /> a <br /> m <br /> Directions for plot plan drawing: 7L <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. L1 <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. <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. <br /> 0 <br /> 0 <br /> PLOT PLAN L l C y L AN E c w <br /> �-- <br /> 1014. 9;L Z <br /> o- <br /> N Cr <br /> O1F , <br /> Y <br /> J <br /> I <br /> _Sl <br /> r nj <br /> �. <br /> i <br /> )BS �Y — a <br /> J' Q <br /> / ,0 <br /> agq .l4 Wo11 oer`"p 2 <br /> o , <br /> y s <br /> DECK MXI _n <br /> l <br /> 9315,C& o <br /> Z <br /> Gf <br /> I � <br /> I � <br /> �- — y ,.{ q l� w AJ E k <br /> yS v��r 0-sa <br /> E5 ` v�� <br /> m <br /> o c C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my V, o <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of allm <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that �Iv ' a p <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing u, <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. <br /> 1� l/�V y m <br /> SIGN HERE 1 �/I/u WAL `- U4— - (O*V'\eR� <br /> (sign4ure of owner or building contractor) (date) E o o <br /> ZONING ADMINISTRATOR L7"1 ir ' • lI f1L;:�'2-ti! �; '. o` 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED Oo0�0P. <br /> 08 <br /> 0 000 <br />