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oil cnMe <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS d 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 2 y o <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- r C <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 a ll <br /> tions of the State of Wisconsin. - <br /> Tosed4, �It�1uNs. y d <br /> OWNER leaseIPrint) Contractor or Surveyor or Agent o. % £ <br /> LIDO c-_W16,41gion �� d t <br /> A�ddss n Address m <br /> /Vew dr jA7-eh MN t <br /> City,State,Zip Coda City,State,Zip Code <br /> 6� -63/s2 6� 1 v, <br /> Telephone Telephone CQ <br /> Emergency/Fire No. and Road Name <br /> �;yer �a ks Gor 17 w �v3 r„r ; , oa7�ors !+-a Xn <br /> Legal Description(as indicated,^ton tax statement) / o <br /> Permit(s)Applied for: ,� .'J CC250'y=Tu Ce Wider- 1400 --f F7— 0 u) 0— <br /> New Building Sanitary Filling/Grading Camping Unit o o <br /> Addition Privy Moving Subdivision 0 <br /> SlGe-aaN Shed 7) <br /> Structure Use: Z a <br /> " (family home/cabin, garage, type of addition, etc.) <br /> Directions for plot plan drawing: <br /> r <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 OF). . <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. ^°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. <br /> O <br /> 0 <br /> PLOT PLAN 3 <br /> --- z c <br /> o a <br /> -- a <br /> y <br /> O <br /> 0 e <br /> t• j � <br /> v r)0 tkrST-n�c b4 IJ'073S ' l <br /> b <br /> V m <br /> 0 <br /> A frox. Awsso0 <br /> i <br /> 0 <br /> � N 1 <br /> i O <br /> 10' '4 <br /> z <br /> 79 ' <br /> p <br /> /DO <br /> WRTer MN V N r D D co a <br /> Mark n Q<> 0. Ra p ;6 <br /> 9 to y 0 O to <br /> Z O 1 <br /> O <br /> m: m <br /> coA <br /> o a C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o: 0 : y <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`' 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 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 /> �j N <br /> SIGN HERE O �A,C-/ d' <br /> (si at re of owner r u'Id'n contractor) (date) ` N <br /> o: o <br /> ZONING ADMINISTRATOR o' o <br /> NON Nm <br /> TOWNSHIP PERMITS MAY BE REQUIRED ����oov m <br /> 0lmA <br /> F_aQ0QQ0 <br />