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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d -0' . --i 0 <br /> PPLICATION FOR — LAND USE — PERMITS 3 _ — <br /> w o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and I 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- <br /> tions of a State of Wisconsin. 46p o <br /> N <br /> OWNER(Please Pri t) Contractor or Surveyor or Agent o O O <br /> Address / �/ Address <br /> 11 To m EV/ <br /> City,State,Zip Code City,State,Zip Code , a <br /> �/a yag <br /> 36?6 -7 �� 3 <br /> Telephone / > D / Telephone <br /> 5-0,, <br /> Emergency/Fire No. and Road Name <br /> — Q <br /> Legal Description (as indicated on tax statement) o n <br /> Permit(s)Applied for o O .� <br /> New Building Sanitary FillinglGrading^�` Camping Unit ' <br /> N <br /> Addition Privy Mb m `y Subdivision 0 o <br /> 1 v <br /> Structure Use: Z o <br /> 0 <br /> (family m ab arage,ty a of addition,etc.) m <br /> Directions for plot plan drawing // p,,v <br /> 1.Show the location and size p�all existi g bui (EB)an all pqW buildings(NB)and indicate No (N). <br /> 2.Show the location of the will(W), sept ( ,and d ai fiela"(DF). � <br /> 3.Show the location of any Jake or ow, a If i hin 1000 nd the location of any river or stream- if wtihin 300 ft. T <br /> 4.Show dimensions in fsetp'f th 0 l0 i g: building to a I t lines,(b)building to center line of road,(c)"12uilding to ordi- <br /> nary high water mark of Jake, Iver ream, if applicable <br /> 5. If,separate plans are sybmitt a chitect,engi err, builder,contr�Cto c.,the plans must be signs and dated by <br /> the owner. II <br /> 0 <br /> 3 <br /> PLOT PLAN �,eAA �1 1 V 1 co <br /> t <br /> 7 � NJ <br /> w� 1 <br /> rn <br /> s 1� <br /> m <br /> 't0 f4N� L�7 LrMr'r � I <br /> -4Z >: <br /> z R�n D C� 0 d G <br /> NQ�Cr•Ta ' L/61 (� p(� <br /> Ol�� O I�VJ m c<w Z 0 a S. m <br /> 0 0•< JJ on–• <br /> D n� �ao =a3 <br /> N N O J 0 <br /> O <br /> U <br /> c : <br /> O <br /> O : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o: j J E 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- c i 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 Burnett relying on this information I am providing in this ap- <br /> plication. I agree to permitbounty officials charged with administer' g county ordinances or other authorized person to have <br /> access to the above desc ibed premises at any reasonable ti f r he purpose of inspection. <br /> m <br /> m <br /> SIGN HERE <br /> (signature of owner or bui Ing contractor) (date) o E o <br /> ZONING ADMINISTRATOR 0 S <br /> w �I <br /> NNON•-��N <br /> TOWNSHIP PERMITS MAY BE REQUIRED u u v u o o u m <br /> 0 0 0 o o 0 00 <br />