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camp, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. 0 — <br /> w o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and y <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the �^ m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. <br /> O <br /> F <br /> 0 E (P se PrinU� Q CoVacto`��M or Agent o ` <br /> pP��dress II AAA�,ddrreess 'dl 11-- r� 1 <br /> Calk'-'CMN . �6'A j 11120D K P �, u. �6oQi * l <br /> Ci y, S te, Zip Code City State,Zip Code <br /> �1 ' Lel�l1l Cpl I; (Al l�l�_7 <br /> Telephone Telephone <br /> - fl <br /> Emergency/Fire No. and Road Name '— <br /> Legal Description (as Indicated on tax statement) <br /> o <br /> Permit(s) Applied for: <br /> Dwelling � Addition Filling/Grading Camping Unit o <br /> Z �{ <br /> Accessory Building Sanitary Privy Subdivision ° } <br /> Garage f1' <br /> ,, ',��., q <br /> Structure Use: �JJ����' a.42L?1AJ � <br /> �J <br /> (family home/cabin, garage, addition, etc.) <br /> Show the location andf all existing buildings (EB) and - Oi (NB) and indicate North (N). o <br /> Show the location of the well (W),septic tank (ST),and drainfield (DF). 3 <br /> .Show the location of any lake or flowage-if within 1000 ft. and the location of any river or stream-if within on c i <br /> 300 ft. o cs n <br /> 4. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building m , H �_ <br /> to lake, river or stream, if applicable. 0 <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C ?I <br /> dated by the owner. m S <br /> O <br /> PLOT PLANi ,.� <br /> �;�rc� <br /> �L1LJLJ /( lUt Irm; lro <br /> z <br /> r <br /> �,y�5�iN6 Um LR, <br /> VY <br /> SU <br /> 6 ' <br /> kA-10 <br /> c � <br /> Fm <br /> m <br /> in M <br /> o = 3 <br /> m o8 m' <br /> z m 5 : m .Z 1 <br /> o f TO rn <br /> f 2,vy <br /> (7-(IT,; / T %.? �J�C)U�J " ` ID <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <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 8 m 8 <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. <br /> p plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have n o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 8 m <br /> A H <br /> � N A <br /> SIGN HERE <br /> gnat of owner or building contractor) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRE, 12 1x91 I 1n N N N O O <br /> -- a 888888 <br />