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P <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d a 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> d O <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and is <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m CD <br /> c <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 a <br /> tions of the State of Wisconsin. <br /> ME l k 1Q U MON a o 0 0 <br /> NER Plea a Pr nt) Contractor or Surveyor or Agent n <br /> � � s L-K <br /> Addressff'�ff e� y� Address m <br /> nAf�t'1 Z�CWti C eIld W( 7�L City, State,Zip Code v <br /> LSrr <br /> Telephone Telephone I <br /> � G <br /> - """. (� <br /> iYp4 /-q '�dicarad on tax �tatemenrl 9 <br /> Permit(s)Applied for: o <br /> New Building Sanitary Filling/Grading Camping Unit o .`.- <br /> m r <br /> Addition Privy Moving Subdivision g o <br /> v <br /> z a <br /> StructureUse: -Mwm <br /> (family hometcabin, garage, addition, etc.) ;J. <br /> onT. Show the location and size o all existing buildings(EB)and all new buildings(NB)and indicate North(N). o <br /> �112. 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. <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. 31 <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and dated by 0 0 <br /> the owner. a3 m <br /> PLOT PLAN Z Q <br /> n ° ` IU <br /> m 0 <br /> fi1TA CHLID y <br /> m o s <br /> d all� <br /> I7V.i rn <br /> 8 �' Cn <br /> n <br /> 0 <br /> i; rm <br /> o � <br /> w <br /> yoomcm <br /> w c < w w o ac m <br /> 0 6": '3'nR =am <br /> m <br /> in � o �m ; <br /> P <br /> mtnl Um' =2 m <br /> Leo ; E O <br /> gn: = <br /> declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o ; , w <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- G=i : 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. I i <br /> oa o: <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 reasonable time for the purpose of inspection. m ? C a <br /> w <br /> m a11- 10 <br /> N�c: <br /> �� w <br /> (si a of owner Iding contractor) (date) g <br /> v: <br /> G: <br /> O: <br /> ZONING ADMINISTRATOR win rnwwww'l <br /> N N O N N m <br /> P o 0 o m <br /> TOWNSHIP PERMITS MAY BE REQUIRED `" <br /> g000$o8Vl <br />