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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrat or m 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS f <br /> 3 = <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 0 <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 /> tions of the State of Wisconsin. - o <br /> N d <br /> C <br /> OWNE.�,R�(Please Pri ,f� Contractor or u eyor or+Agent --1 ; a' £ <br /> -bite(Il/!%Y - ,., <br /> Address Address <br /> City, State,Zip Code City, State, Zip Code F I <br /> �u CT �`I�t <br /> Telephone Telephone <br /> lis- C-3 -/06e-DS47- �9�7 iii ' - 0 <br /> Emergency/Fire No. and oad Name <br /> L r/c� %. VO—K> <br /> Legal Description (as Indicated on tax statement) o .i <br /> Permit(s)Applied for: <br /> New Building SanitaryFilling/Grading Camping Unit o <br /> Addition Privy Moving Subdivision NB 0 <br /> Structure Use: z0 0 <br /> (family home/cabin, garage,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). <br /> 2. Show the location of the well IN, 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. <br /> O <br /> 0 <br /> PLOT PLANf� 3 <br /> ��� Attache 0 Wz <br /> o a <br /> y <br /> 0 <br /> d <br /> I <br /> 0 <br /> 0 <br /> _ <br /> N <br /> 0 <br /> N � <br /> J <br /> Z <br /> Bm , <br /> 5�ba c l(< Ue ri 44�io� i nC(iCn�d A Carner6r�_C�ec K w%/1 de -3v 7e cle5e lie c 1j � � �m r D D m -0 <br /> / ,,( �pnac <br /> CII l /Ch Q� erm, l Q,1 i�� Y� � _ 2 4 f4 s n Q< o n a a <br /> R � � 14 -�7p/'e Oti� TCJ�-ho7,e �2 hlotv�( m arc m n w _ <br /> o <br /> 73acKo ; <br /> m <br /> l-t L{a (�5 m <br /> to <br /> I declare that this a lication(including an accompanyingschedule has been examined b me and to the best of my knowl- o. :� :4 <br /> PP 1 9 Y ) y _� i <br /> edge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all informa- : $ m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- :d o: O <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 :mom <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. I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> tD N: <br /> SIGN HERE <br /> (s' net a of owner i ding contractor) (date) �/ti `: ':3:0: <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED ^ ^NN(POO'o N j P, m <br /> IT ,a�m <br /> oSoo oo�rA <br />