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c"1 ( c --)1 ' - <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator M o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> d <br /> a <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work describ _ o <br /> ed and m <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- <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. p <br /> N � <br /> FRA,riT Gg�c 7 SE L F <br /> OWNER(Please Print) Contractor or Surveyor or Agent n F <br /> 7 / X7 ENG& B2crsom rPy <br /> Address Address � <br /> WFi35TF/� <br /> City,State,Zip Code City, State,Zip Code I <br /> Telephone Telephone <br /> x '711? 7 <br /> Emergency/Fire No. and Road Name <br /> Lei 7 S& / tt,Wty5N/J 3X 416PAY. 917AllI. <br /> Legal Description (as indicated on tax Statement) �— /(, <br /> Permit(s)Applied for: O <br /> X <br /> 0 <br /> New Building '` Sanitary Filling/Grading Camping Unit 3 `- <br /> N <br /> Addition Privy Moving Subdivisiono 0 <br /> Structure Use: G fq Rs)G 7a Ix Ra o o n <br /> (family homelcabin, garage, type of addition,etc.) m rJ <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 drainfield (DF). o <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 ordi- <br /> nary high water mark of lake, 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. n <br /> 0 <br /> PLOT PLAN 3 <br /> �e�e�ls L A KE o <br /> LDn <br /> 4 0 <br /> y <br /> Uv !, <br /> r lAl <br /> r <br /> sa� � <br /> m <br /> 0 <br /> S1 <br /> �u Z <br /> s .�17i <br /> QL fi l� <br /> M <br /> cr m <br /> m : � 0 o3 <br /> _ ^ <br /> - CACc <br /> D <br /> 8i i I : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o i <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- Ao 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. 1 a <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. <br /> T <br /> SIGN HERE _/ /C (' <br /> (sign of owner or b ' contractor) (date) [ o o <br /> ZONING ADMINISTRATOR I o <br /> o: o <br /> P. M JNON � <br /> TOWNSHIP PERMITS MAY BE REQUIRED ` �`"�'� <br /> 00000 <br />