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(.4 1 <br /> Burnett"County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d 0 o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m o <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 n <br /> tions of the State of Wisconsin. <br /> c �1 <br /> ' II-rim O <br /> OWNER(Please Pritto Contractor or Surveyor or Agent n f <br /> o = <br /> rg � l _1Aa3/ Address O <br /> y,l Stc�,Z Zi Cod_ /iI I 1 City, State, Zip Code <br /> kil � r c a v <br /> Telephone 0 lep <br /> EmeKencyolFire No.and Rme oad afirn / C P moi , -vu + E + 7 0 <br /> Legal Description (as indicated on tax statement) }-• ILI <br /> — <br /> Permit(s)Applied for:, O <br /> 0 <br /> New Building Sanitary _ Filling/Grading Camping Unit 0 <br /> r <br /> Addition Privy Moving Subdivision o <br /> I v <br /> Structure Use: �) <br /> family home/cabin, garage,type of addition, etc.) m <br /> Directions for plot plan drawing: <br /> Cl. <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North (N). N <br /> 2. Show the location of the well (W), septic tank(ST), and drainfield (DF). (A 0 <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. CA <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 z <br /> 0 m r, n <br /> 0 <br /> O <br /> _ <br /> t o <br /> 3 <br /> Y\ mfr A C <br /> s <br /> r�� iLJ X72 o <br /> ,fox' o <br /> FFy 77) Z <br /> D <br /> 2 m n a cm m <br /> '—n m a n � <br /> '2 o 0 3 <br /> SIW " wNZ. Z o`I 2 <br /> b1)/`rsr " f—_763 )r To o = IN #nE 70 <br /> 1?5 — Rom)_ 'Drtye,, • U V1 c i i [ D <br /> o�a: C <br /> PP (including Yaccompanying ) Y y per: .�= nE MI <br /> I declare that this application includin an schedule ha been xamined b me and to the best of m know)-o o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- (J ' �m o' '. m <br /> tion contained in this application includin an accompanyingschedule and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by he County of urnett Wisconsin in determining whether to issue a permit. I-C <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am provicrn in this aa"�i <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to haves <br /> access to the above described premises at any reasonable time for the purpose of inspection. 1 "•"' <br /> - n: <br /> 0 0: <br /> SIGN HERE O <br /> (sig ur of own u ding contractor) (da e) <br /> U : <br /> ZONING ADMINIS RAT )R a ingi <br /> w-n <br /> VNiNN(NTOO m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 0 m <br /> 000000 N <br />