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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w M 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <br /> located as Ihown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- lJv <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- <br /> tion! be State of Wisc n p V.J <br /> — OWI r A10m1h awn BLa6o.c a F <br /> OWNER(P se Print) Contractor or Surveyor or Agent o _ <br /> 20 A U �y(/�Efc� 9"VE- 6%sS <br /> A d ess � Address � <br /> I n LS �?.i/ 6_:Yl ' I�,g �.G c� sV o 3d o 9 <br /> Clty, State, Sip ode City, State,Zip Cod I I G <br /> Z zz X55- 3a52 g; _s <br /> Tblephone Telephone d J <br /> fail tea' <br /> Emerrec ire/o. ands Name + j <br /> /y1 V(/,j / �G �3: 1, <br /> Legal Description(as indicated on tax statement) <br /> Permit(s)Applied for: = C) <br /> / 0 <br /> New Building Y Sanitary � Filling/Grading Camping Unit m <br /> ct- <br /> r <br /> Addition Privy ,,. , .���Moving Subdivision o ° <br /> Structure Use: / ' '"' "" i �� 0 a <br /> (family homelcabin, garage,typ of addition,etc.) m <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). 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. o <br /> 3 <br /> PLOT PLAN a m <br /> Z Q <br /> a <br /> '/'/'') I-� yi c C-4C-4 1`10 n- <br /> / e 'T 90 -�. <br /> I�. <br /> \ ✓O Y a <br /> N `� <br /> t o` o <br /> a0 � Iv C <br /> Z <br /> D <br /> FE, <br /> ,-II <br /> SEP � � �iI I M NVIOr DD W � <br /> / !I I c I JLr ��� ) m, Z. 3 n m a a <br /> a 7/qo fir. , a <id 0 o o� 3 <br /> o zP � �m � <br /> o i': m <br /> p10 N <br /> :�n: m <br /> o: o n» <br /> o: coo: 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 y <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa. ao `. 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 ounty of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which may be a re It o the County of Burnett relying on this information I am providing in this ap. <br /> plication. I agree to permit unty o icials ha ed with administering county ordinances or other authorized person to have <br /> access to the above desc d pre es ' y easonable time for the purpose of inspection.It <br /> oEd++ <br /> SIGN HERE Z-6 <br /> V:3: <br /> (sfgnaturg 6f owner or building contractor) (d te) <br /> ZONING ADMINISTRATOR o " ` <br /> oi 'n:nio� <br /> n o o m <br /> TOWNSHIP PERMITS MAY BE REQUIRED ogory <br /> o � <br />