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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m a o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 'z m <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m <br /> m <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 a <br /> tions of the State of Wisconsin. <br /> 1 Flb/Ylfts 'If"��f�^� <br /> OXE30(Pleasoas1 Dr' Cont <br /> r lSudor or Agent O <br /> a <br /> m <br /> Address -7 Addrass - Imo, <br /> it,I a,Zip CpdeCity,State,Zip Code <br /> Telephone !�s"'/ TelephonnP 1 <br /> `fin/ OD Sl C"- Ln <br /> F,�yn�erppency/Fire No.pnd Road Name <br /> YCC ff0, llo, /53. 0336 Rtv�r-O,%kc <br /> Legal Description (as indicated on tax statement) <br /> 0 <br /> Permit(s)Applied for: O <br /> New Building _ Sanitary Filling/Grading Camping Unit <br /> Fillin /Gradin 0 °_ <br /> Additionm <br /> Privy Moving Subdivision � <br /> v -- <br /> Structure Use: o 'o <br /> (family home/cabin,garage,addition, etc.) <br /> m <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). o <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 M O <br /> the owner. 00 <br /> PLOT PLAN I' - on Zco <br /> o a <br /> c <br /> m ui <br /> I c <br /> W Z <br /> I � m <br /> m <br /> 5-0 <br /> 16- p <br /> K( V <br /> l <br /> a <"; `Z �m ' p 0 6-'; <br /> Z N f0 <br /> 21 A <br /> N =2 € ` m <br /> PP (including Yaccompanying ) S <br /> O» 0 <br /> I declare that this application includin an schedule has been examined by me and to the best of my knowl- <br /> edge o: m <br /> edge and belief it is true,correct and complete.I acknowledge that 1 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- i i»Ain: p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit 1 ': c g <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this a,- , o. <br /> plication.I agree to permit county officials charged with administer'ng county ordinanges or other authorized person to have g' <br /> access to the above described premises at any reason a time the purpose inspection. O <br /> SIGN HERE <br /> ( ' not re of owner in contrac r) (date) <br /> ZONING ADMINISTRATOR <br /> hin�inain in�l <br /> TOWNSHIP P ITS MAY BE REQUIRED P rn ten.P 9 6 m <br /> googggormA <br />