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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d --I o <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 io <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m m <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 State of Wisconsin o <br /> -Tvri <br /> OWNER( Pring Contractor or Surveyor or Agent a E <br /> e m V D <br /> AddreAddress :? I <br /> T ff2414-I�e�- AV SSD 82 J J <br /> City,State,Zip Code City,State,Zip Code <br /> Telephone sTelephone O <br /> ap/s S� Alm Row <br /> Emergency/Fire No. and Road Name <br /> sFY4 o NW S'y se`o1` <i T3971t' w 171e�ron/ <br /> Legal Desc ption(as indicated on tax stateme t) o <br /> Permit(s)Applied for. O <br /> New Building Sanitary Filling/Grading Camping Unit 0 <br /> N <br /> Addition Privy Moving Subdivision S o <br /> l-1• , /i c // z v <br /> Structure Use: ` , S `� (7/� o m <br /> family home/cabin,garage,addition etc.) z <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. /o o <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. <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, C \ <br /> river or stream, if applicable. M <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and dated byn <br /> O <br /> the owner. o <br /> 7I a co <br /> PLOT PLAN Slee _y,��j �I z Q <br /> ,-N" O � o a <br /> JlQ ��2i:P m - = <br /> C h <br /> M w <br /> R' c <br /> C, <br /> c <br /> a- o <br /> 70 <br /> Z <br /> \7 01 9 <br /> r <br /> 1100 ��pw�i :1) c-0m nnc-0 <br /> v = = nn-•m <br /> _03-L = i -n fpi <br /> i — <br /> im <br /> sa, = <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- (> S � <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- =p n: G <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i.9$N': <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to issue a permit. I ((�, <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. E O^o <br /> SIGN HERE <br /> (sig re of owner r Iding contractor) (date) `• o i <br /> ZONING ADMINISTRATOR �7 <br /> TOWNSHIP P MITS MAY BE REQUIRED8y <br /> Cy$$$o <br />