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k_�f l �r y�tl, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratoru 7 o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> d o <br /> y <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 <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3, o- <br /> tic s of the State of Wiscoonnsin.,/� I J 'y� y d <br /> VIICErE11 a 0 <br /> OWN <br /> Please Print Contr or or S rye r or t o J <br /> Ad4Vss Addrre <br /> City,State,Zip C de City,State,kip Code <br /> — 1 ' <br /> Telephone Telephone <br /> Emergency/Fire No.and Road Name <br /> Legal Description (as indicated on tax statement) <br /> Permit(s)Applied for: o O <br /> o l_ <br /> New Building Sanitary FillinglGrading Camping Unit y -�-' <br /> Addition Privy Moving Subdivision o <br /> C) <br /> v <br /> Structure Use: P m <br /> (family homelcabin, 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 (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. <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. o <br /> 3 <br /> PLOT PLAN a m <br /> 0 c <br /> o n <br /> N <br /> 1n J <br /> as �1 <br /> a <br /> 0 <br /> J <br /> N <br /> O <br /> J <br /> O <br /> N � <br /> ^ I� <br /> Z <br /> 1 <br /> C <br /> p U)vrnrDDWa <br /> m a� 'nm ani <br /> O O � � -4 <br /> ^ m <br /> u : p <br /> 8 a; c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o I J : ; y <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all info a- 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 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 /> m <br /> m <br /> m <br /> SIGN HERE <br /> (slcr re of owner ohhbuilding contractor)1l (date) " v, <br /> 1�� 7 f�L li hf�rU o <br /> ZONING ADMINISTRATOR <br /> � m <br /> IJNOiJ ��N m <br /> M <br /> TOWNSHIP PERMITS MAY BE REQUIRED c v v u ooy <br /> 0000gooN <br />