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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratoru ( a o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 0 <br /> located,as shgwn herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- ? <br /> nett County Land Use Ordinance,Sanitatio Code,sod with II other ap licable County Ordinances and the laws and regula- 3 a v <br /> do of the State of Wisconsin. ^' o <br /> 5 5_ even Ne�boN� C 3 G <br /> OWNEII lease PryOt) n 1 Contrac or or Surveyor or Agent n � F <br /> drUss ELI ()JD Address m ,� <br /> 'yY1L ok. L�1 I J . <br /> City„S ,Zip Co (n City,State,Zip Code I ` <br /> Teleph on -7 Telephone <br /> Emeerge'ncy/Fire No. and Road Name <br /> Legal Description (as indicated on tax statement) o <br /> Permit(s)Applied f <br /> 0 <br /> or <br /> New Building Sanitary Filling/Grading Camping Unit 0 <br /> N <br /> Addition Privy Moving Subdivision o ^°r. <br /> Structure Use: all_C 60mE o 0 <br /> (family home/cabin, garage, type of addition, etc.) m <br /> a <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). r <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 /> r <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. 0 <br /> PLOT PLAN -o <br /> m <br /> Z c <br /> C) <br /> :�v_ r Mel"6�J o- ¢� /✓� <br /> I f' a <br /> c 4 m <br /> n <br /> I • 00 <br /> o <br /> 0 <br /> O <br /> y c <br /> 71* <br /> Z <br /> LM Z <br /> Z�* <br /> N C <br /> M. r�DDWy <br /> .N 0 0 a c <br /> –. m <br /> a <' °1c0n <br /> N <br /> «i m <br /> o o C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- -i c T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- rJ o: <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I n <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 /> SIGN HERE <br /> gn ure of ow wilding contractor) (date) <br /> ZONING ADMINISTRATOR o <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> o' 0 000 <br /> �0 0 000CA <br />