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Burnett County 7410 Co. Rd. K, 1102, Siren, MI 54872 Office of Zoning Administrator m m o 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 m <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m c <br /> nett County Land Use Ordinance,Sanitation Cade,and with all other applicable County Ordinances and the laws and regula- 3 n <br /> tions of the State of Wisconsin. p / <br /> 10 <br /> OWNER(Please Print) Contractor or Surveyor or Agent o ` <br /> FooD "y - �_O' <br /> Address Address <br /> City,State,Zip C� City, State,Zip Code <br /> 61-,7- 1/7y- WV90 <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit n o <br /> Privy Subdivision w <br /> 0 <br /> Structure Use: R I ` I�\�l <br /> (family home/cabin, garage,addition,etc.) o <br /> Directions for plot plan drawing: r <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. 6. Provide legal land description. 0 <br /> 0 <br /> PLOT PLAN <br /> a rn <br /> �/!�, <br /> 0 a <br /> 5 <br /> t ,GI I J <br /> I v <br /> I <br /> /j N <br /> O <br /> J <br /> / J`jye �p <br /> Eloo.'--� o <br /> \ 4r <br /> I o <br /> ,1 Z <br /> i <br /> ---- - hh <br /> rn r D D W m <br /> C m n am ani <br /> c 5 co 5 5 3 <br /> A H 'o J O <br /> Z 0 <br /> rn: A <br /> WN 2 m <br /> o: n : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o <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 /> information contained in this application(including an accompanyingschedule and I furtherdeclare that I recognize that O <br /> PP ( 9 Y ) 9 ; p <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 a <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 /> m <br /> m <br /> SIGN HERE <br /> re of owner or ui g ontractor) (date) <br /> ISTRA ': o! L" <br /> ZONING ADMIN TOR <br /> OWNSHIP PERMITS MA/ BE REQUIRED �. u v,00pm <br /> 0 a 0c) <br />