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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m Q 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 £ <br /> d <br /> r <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 0 <br /> 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 /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 a 1 V I n <br /> tions of the State of Wisconsin. m o C> <br /> p N <br /> LjeA Nc,nr%'(J) Pek1�e -A'jt" m O <br /> OWNER(PleasePrAint) Contractor or Surveyor or Agent 0. £ <br /> Awl balciwtrt rCle- 1-)30 (>locl_ 6�4r 7/ 0 Ul = <br /> Address Address <br /> Lino Lakes Mn SSOIbD-y, bue-1 WI 15010 , j— <br /> City,State,Zip Code City, State, Zip Code — <br /> L11-1A'4_1535 "115'-691. -3141 Cy � <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name <br /> 1,130 (D1ack. 3eor -bail yt R I-7 lo+ 67 <br /> Legal Description(as indicated on tax statement) /1 �� _ e� �� ,3 0 <br /> Permit(s)Applied for: ,1y,�rq�- AAQn," ,)C7w+-+>�lt-u r. �''^�' �a' Kai � w n Gf <br /> o <br /> New Building Sanitary Filling/Grading Camping Unit 6 .`.- <br /> N ti <br /> Addition Privy Moving Subdivision o n <br /> Structure Use: —sCsaett[IU o S T <br /> (family homelcabin, garage,type of addition, etc.) 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 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. 0 <br /> 0 <br /> PLOT PLAN M l l # 97tjr� 3 <br /> N See/Der _P N <br /> Z <br /> o Q <br /> 0 <br /> 0 <br /> 4J ' <br /> o� <br /> \\D1 I <br /> Aj o <br /> � 0 <br /> I <br /> QEc� I o , <br /> SZ), <br /> 596 <br /> i I <br /> AW'' �'t%➢�'^ Z <br /> � <br /> J <br /> � bl <br /> n mvwraamm <br /> w c o w w o a c <br /> I <br /> ? �_ 'tnt m <br /> EY� Sfiu � LAS C�Gu �- _ l e- C J 0 O <br /> r rv : <br /> b 'I�Aasl <br /> o: �a C <br /> I declare that this app(cation(including any accompanying hedule)has been examined by me and to the best of my knowl- y <br /> edge and belief it is true,correct and complete. I acknowledge that I 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- <br /> mationI am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I a ; <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- _D i <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above ed premises at any reasonable time for the purpose of inspection. Eu+: <br /> m N: <br /> $ -at-9a e3 i i Moi i <br /> SIGN HERE v :o: <br /> Is natu of owner o ng convector) (date) I !oN <br /> oa ; ;wo <br /> ZONING ADMINISTRATOR �'Y_ ` o m .n o <br /> A N :ro <br /> -n <br /> NNON + m <br /> (T(T tT(n O O <br /> TOWNSHIP PEflMITS MAY BE REQUIRED o o b o 0 o ism <br /> 00oo oc>= Cn <br />