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7410 Co. Rd. K, /102 - Ij <br /> b, <br /> Siren, NI 54872 <br /> Burnett County Office of Zoning Administrator d 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 'z m n � <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m 7✓ <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- <br /> tions of the State of Wisconsin. o <br /> `-J(�I I I1 aY1Q ,' Il l lafl( CV(.151 lN! (JV V1 C t-y7 IQ, a O <br /> OWNER(Please Print) Contractor or Surve or or Agent <br /> Address AdZr (ML. <br /> t / 1. <br /> City,State,Zip Code City, State,Zip Code v' -� <br /> I <br /> Telephone Telephone <br /> Permit(s)Applied for: Cp <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit o <br /> Privy Subdivision .`.• <br /> m r <br /> 8 0 <br /> Structure Use: v <br /> (family homelcabin,garage, addition, etc.) o 0 <br /> m <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). <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. <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 /> 6. <br /> PLOT PLAN a legaldescription (on a side o is form) as on ax statement. 3 <br /> c � <br /> Z c <br /> O a <br /> y <br /> B <br /> Z <br /> i fn <br /> 0 <br /> 0 <br /> n � <br /> O L. <br /> ❑ 1�.�^] <br /> 7 <br /> O <br /> N � <br /> n_ <br /> m <br /> 'm <br /> Z <br /> 0 <br /> Z <br /> m c m w m n a c m <br /> n o-a o m <br /> m a" - am »nK <br /> c °cmo3*3 <br /> o � � o MQ <br /> o � 1 <br /> m <br /> �jlj50 <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m o c I C <br /> PP ( 9 Y ) Y Y o; [ m E y <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all ? m <br /> PP (including Yaccompanying ) g ` n <br /> information contained in this application includin an schedule and I further declare that I recognize that <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a o <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing n <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> N ' <br /> A <br /> A <br /> SIGN HERE <br /> (si ature of owner or building contractor) (date) l o o <br /> o: O <br /> ZONING ADMINISTRATOR <br /> N N O V N m <br /> TOWNSHIP PERMITS MAY BE REQUIRED n n nu oo<nm <br /> Doo 000gfA <br />