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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <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 5 S <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 0 <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 o. <br /> tions of the State of Wisconsin. = o <br /> �iC l�o f1�0� COY �t1 C <br /> u C`i-t OL� n 0 o <br /> 1111111111111111WPlease Contractor or Surveyor or Agent ) F <br /> tint)�siP RQ vo ux Avg. So- ,\26 C'w-zoc)Pd +ick s'6- <br /> Address S <br /> s�>/�.e /f1,y. -5753 -3 -7 <br /> Zip Cod _ 890 - 7g 78 City, St�de 'n <br /> n r Telephone 0 <br /> CQ Pf 6 If <br /> MiNNINNOW're No,and Road Name <br /> Legal Description (as indicated on tax statement) <br /> Permit(s)Applied for: O <br /> 0 <br /> New Building Sanitary Filling/Grading Camping Unit 0 <br /> N <br /> Addition Privy Moving Subdivision g ,or, <br /> clvo��� y `fir a0 ` ?�o Z o N <br /> (family home/cabin, garage,type of addition, etc.) P m <br /> _ <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 r tream - if within 300 ft. <br /> 4.Show dimensions in feet of the following:(a)building to all lot lines, .. ", . , (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 a cn <br /> 3, �JL Z <br /> -3P <br /> 0 <br /> 31 0 <br /> Oq <br /> c o 0 <br /> --- <br /> SDO'-r <br /> � Z <br /> S <br /> yvmrDDWy <br /> M Q W00a` m <br /> 0c00o� 3 <br /> Z rn ? � o0� � <br /> m <br /> 'nom <br /> v,o: i�~.� iai <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o : :"D <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- Cc I m A i m <br /> ao; <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 0 <br /> u? <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 o <br /> access to the above described premises at any reasonable time for the purpose of inspection. fn <br /> T fv; <br /> SIGN HERE <br /> y in <br /> (sig ur of owner 'Iding contractor) (date) <br /> ZONING ADMINISTRATOR 00 n o <br /> ni ro <br /> 100, <br /> NNON �-•If} <br /> TOWNSHIP PERMITS MAY BE REQUIRED p1-"`"OiOOO m <br /> 000o oo�(A <br />