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6(\ C )-f� f <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. o — <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and a m <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- <br /> tions of a State of Wisconsin. m <br /> 7`iam.sS /Z'/. /�� Se /F <br /> r <br /> OWNER(Please PrripR Contractor or Surveyor or Agent o a f <br /> Address Address `D C Z' <br /> City,State,Zip Code City,State,Zip Code <br /> 11 3 c9 -7 <br /> Telephon��SON R4 > DC/ Telephone <br /> Emergency/Fire No.and Road Name �`e �f.- <br /> Legal Description (as indicated on tax statement) <br /> Permit(s)Applied for:• n c1 { <br /> Y✓ o <br /> New Building Sanitary Filling/Grading Camping Unit m M <br /> r <br /> Addition Privy Moving Subdivision o ° <br /> )l1l�FiIT��I� o <br /> Structure Use: o <br /> (family homelcabin, garage,type of additi n, 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 (W) septic tank(ST), and drainfield (DF). <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. 1n1 1 r <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. t7 <br /> 0 <br /> 3 ` <br /> PLOT PLAN <br /> / ZA\ ® v N <br /> c <br /> { o 0 <br /> 7 l � <br /> I 9 N <br /> N /I ? <br /> l� <br /> V� I a <br /> �Ai <br /> N <br /> O <br /> St�S+r�4 <br /> _ o <br /> 0 <br /> B U en I00 ' 7— <br /> YapN� L� FLraut <br /> 7S' {moi uEQ� _ m o m � <br /> —`+��vewoq ne-d�-to Ix br�c:r -(:::uOCT 0 1989 i am <br /> to11ar / m <br /> U-1,t�Yil. 7"SGV�i4o o E° � <br /> f 0 : (n A <br /> �V�30�a�1 N rn <br /> o f D i C <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 <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 /> T <br /> N <br /> (D <br /> SIGN HERE <br /> (signature of owner or bui ing contractor) (date) <br /> ZONING ADMINISTRATOR <br /> _ T <br /> TOWNSHIP PERMITS MAY BE REOUIRED oNoc <br /> o� o <br />