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Burnett County 7410 Co. Rd. K, 1102, siren, MI 54072 Office of Zoning Administrator in _ o' o <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> d o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m c <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. o <br /> N n <br /> a <br /> OWNER(Please Print) Contractor or Surveyor or Agent <br /> 33 9 5 k'- 7P s4 -e <br /> Address Address <br /> ✓ <br /> City,State,Zip Code City,State,Zip Code S <br /> Telephone Telephone <br /> Permit(s)Applied for: $ <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit n o <br /> Privy Subdivision 0 <br /> m r <br /> Structure Use: <br /> (famil home/cabin, garage, ad tion,etc.) o <br /> m <br /> r <br /> Show t nze of all existing buildings(EB)and all new buildings(NB)and indicate North(N). <br /> Show the location of the well (W) septic tank(ST), and drainfield(DF). <br /> 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 /> 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 /> If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and dated by <br /> the owner. 6. Provide legal land description. O <br /> 0 <br /> PLOT PLAN 3 N <br /> a <br /> ^ (/yi y� <br /> t, got 3 Lafe o <br /> to <br /> V J'G o 0 <br /> ac N <br /> 0 �I <br /> JffJ i ion i � � 1 <br /> Ij 3 S, ' <br /> b z <br /> b" <br /> 0 <br /> Z <br /> ,4 T /� (�� N7.711 on rnvmr D Deo <br /> e - <br /> Lidl h r� I J ��. (-y'� i7 n Z':W C W n=.m <br /> U m am =am <br /> a <� w cy o 53 <br /> 5F1-- T(s SJ kf <br /> rn <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of mym <br /> � <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all i : m <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that > O <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a <br /> o : <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing i � <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized <br /> person to have access to the above d scribed pre ises at any reasonable time for the purpose of inspection. ' <br /> m <br /> n m <br /> w m <br /> SIGN HERE <br /> (sig ure f ner or bu' i co ctor) <br /> ZONING ADMINISTRATOR i <br /> o; a <br /> o: b <br /> y� <br /> TOWNSHIP PERMITS Y BE REQUIRED WV - 5 " " N m <br /> v,v,v, o m <br /> li 000 0of� <br />