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CC) ) <br /> 0) V <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 3. — <br /> y <br /> TO THE'ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described 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 /> li s of-t eState of Wisc usin. <br /> N C i <br /> V D p O <br /> OWNER(Please Print) Contractor or Surveyor or Agent a d) f <br /> 2B" �0 7sc o <br /> d <br /> Address , Address <br /> City,State,Zip Odds City, State,Zip Code 1 <br /> Telephone Telephone ^ <br /> EmergencylFire No. and Road Name <br /> -�N, Z8 6-0-7 <br /> Legal Description (as indicated on tax statement) <br /> Permit(s)Applied for: »' o <br /> New Building Sanitary — Filling/Grading Camping Unit m <br /> r � <br /> Addition � Privy Moving Subdivision o <br /> Structure Use: -�Hril r o 'o <br /> (fan ily home/cabin, garage,type of addition,etc.) � <br /> r <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). W <br /> 2.Show the location of the well (W), septic tank(ST),and drainfield (DF). 3 <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. o <br /> 3 <br /> PLOT PLAN P m <br /> 0 (h a <br /> ee_ J�b��C �PO� D2i <br /> 7 �h <br /> I � <br /> e <br /> I N <br /> y o <br /> lJ o <br /> N <br /> � 211 VV <br /> O <br /> O <br /> Z <br /> (n <br /> qui T <br /> 33 m r D D W <br /> mC = NNnac <br /> o_ a =' Ma <br /> LD. <br /> <: m <br /> 5.5. <br /> 3 <br /> v i o om <br /> Z <br /> o: 0 <br /> o: o` C <br /> ,plication(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> ,us,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- o m <br /> oplication(including any accompanying schedule)and I further declare that I recognize that this infor- o G <br /> w <br /> gill be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. <br /> which may be a result of the County of Burnett relying on this information I am providing in this ap- <br /> '.ounty officials charged with administering county ordinances or other authorized person to have <br /> �d premises at any reasonable time for the purpose of inspection. <br /> m <br /> lure of owner or to ild*iTg contractor) (date) o <br /> V: <br /> Gi <br /> �S P- FLn rAr <br /> 1€ <br /> o: o <br /> JNSHIP PERMITS MAY BE REQUIRED m <br />