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kv�e-Fti v ( l CDP) / - <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Adrninistrator m - ; o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> co o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and w O <br /> located as shown herein.The undersigned agrees that all work shall be done In accproance with the requiremen s of the Bur- m <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the law 3 and regula- �_ n <br /> lions of the Slate of Wisconsin. v S <br /> N � <br /> OWNER Plea a Print) Contractor or Surveyor or Agent £ <br /> wafr_k R�/ m <br /> Address ?la . �N `mss/!9 Address m <br /> City,State,Zlp Code City,State,Zip Code <br /> /-(0/2' 738''/�/t�.3 SlAeA1 344-6-74j{ I <br /> Tel phone .#. Telephone rt . <br /> Emergency/Fire No.and Road Name n <br /> Legal Description(as Indicated on tax statement) o <br /> Permit(s)Applied for. o <br /> New Building Sanitary FIIIInglGrading Camping Unit <br /> w <br /> Addition Privy Moving Subdivision li 0 <br /> a' <br /> I it <br /> Structure Use: �r 9 <br /> o <br /> (family homelcebin,garage,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). or <br /> 2. Show the location of the well(W),septic tank(ST),and dralnfield(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, 0 <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 /> 03 <br /> PLOT PLAN !� �.�, /!O�' 1"GY �� / , .�}-,oLTY� r �I o <br /> C 114M 1�ake m I <br /> ^' <br /> 701 t.__ 0�1 10�8twa Road —. Q <br /> V�' Orfi O 16 4, <br /> s <br /> 0 1 <br /> 1� N r <br /> _ I Z <br /> M N�NCCDDDy <br /> C49 Ham <br /> � S »a0 =a0 <br /> ;F: 065C <br /> mZ mn � <br /> E n i E M <br /> �gi E nc i i C <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- ,S:g; <br /> edge and belief It Is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy o if all Informa- <br /> tion contained In this application(including any accompanying schedule)and I further declare that I recognize t tat this infor- O <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I <br /> SE , <br /> further accept all(lability which may be a result of the County of Burnett relying on this Information I am provid ng In this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have i E <br /> access to the above described premises at any reasonable time for the purpose of Inspection. <br /> Jap N i <br /> SIGN HERE <br /> (s nat re of owner (ding contractor) (date o E <br /> ZONING ADMINISTRATOR '• i g i ' <br /> �� rn <br /> TOWNSHIP PER ITS MAY BE REQUIRED '"� ��- m <br /> $$$8888 CA <br />