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�nccNp 3 <br /> County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrat r m -o -i a <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> 0 <br /> TO THE ZONING herein. he undo R: The undersigned hereby makes application for a Permit for the work described and m <br /> Bur- <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- <br /> tions n O <br /> tions of the State of Wisconsin. C r 0 <br /> N <br /> OWNER(Please Print) Contractor or Surveyor or Agent F <br /> a dal car oc <br /> Address -7 Address Rim Q) Sk <br /> C,fc1e Q;hts �,yvti\ SSoI� <br /> City,State,Zip Cdell - City,State,Zip Code <br /> Telephone Telephone <br /> Emergency/Fire No.and Road Name <br /> Legal Description(as indicated on tax statement) v <br /> Permit(s)Applied for: n' <br /> New Building X SanitaryFilling/Grading Camping Unit 0 ` W <br /> N <br /> AdditionPrivyy / Moving Subdivision g o <br /> Structure Use: � �, � I tet"Y.A z � <br /> 0 <br /> (family homelca in,garage,type of addition,etc.) ° <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 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 3 <br /> v <br /> Z v <br /> n <br /> iifn u /Obi — <br /> • <br /> 1 <br /> U) <br /> m <br /> 0 <br /> 0 <br /> S 0 <br /> 3 <br /> J � m <br /> o <br /> N D <br /> h <br /> 3 <br /> 90 FT m c to cm c <br /> rn <br /> p ,O <br /> L� k <br /> a 2 Q <br /> 1 declare that this application(including an accompanyingschedule has been examined by me and to the best of my knowl- <br /> edge <br /> PP ( 9 Y ) 0 : <br /> edge and belief it Is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- 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 ` m <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 /> m <br /> m <br /> SIGN HERE <br /> (sign re of owner or�build�'�,cootr�ctor) (date) <br /> ZONING ADMINISTRATOR Y Y�1T1V l B <br /> 8 i i 8 <br /> TOWNSHIP PERMITS MAY BE REQUIREDtu <br /> N O N N m <br /> N N N N <br /> 8888 rmn <br />