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oil ( oil , r- <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d M o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d o <br /> TO THE ZONING ADMINI&TRATOR: 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 Bur- <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 n <br /> o�^of the e Stalof Wisconsin. <br /> rh Q <br /> l� Le jT11 N <br /> C N <br /> OWNER(Please Pri ) Contractor or Surveyor or Agent n F <br /> 37aa �a OUG . S_ ° <br /> Address II Address <br /> Mf11S � SS�01 <br /> City,S te,Zip Code City, State,Zip Code <br /> (Oka - -In - 1000 t <br /> Telephone Telephone <br /> Emergency lFire No. and Road Name (� <br /> l7� ` <br /> Lr� � 3S OF Parlors lvt.- PjAt <br /> Legal Description (as indicated on tax statement) <br /> Permit(s)Applied for: 0 <br /> 0 <br /> New Building Sanitary Filling/Grading Camping Unit m <br /> r <br /> Addition Privy Moving Subdivision o ° <br /> iu 0/7�l/ <br /> Structure Use: 0 a <br /> (family ho a/cabin, ga ge, type of addition,etc.) '^ <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). �J <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 fl. 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 (J�, <br /> the owner. o _ 1 <br /> 3 <br /> PLOT PLAN Z o <br /> o n <br /> y <br /> 1 0 <br /> 1 <br /> a <br /> m <br /> N <br /> I <br /> Z <br /> JJ <br /> I <br /> G <br /> N C A aCmm <br /> n <br /> Cr< n- m <br /> 0 3 <br /> N O nm <br /> O j i <br /> N <br /> m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- o m <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 a <br /> further accept all liability which may be a result of the County of Burnell relying on this information I am providing in this ap. <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described prems at any a sonable time for the purpose of inspection. <br /> T <br /> N <br /> N <br /> fA <br /> SIGN HERE <br /> (sign ur o owne i ing contractor) 1 (dike) o: o <br /> o: b <br /> ZONING ADMINISTRATOR o: o <br /> -n <br /> V N O N P N m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o.b b o o 8 <br /> CA <br /> m <br /> o <br /> 0000 <br />