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7410 Co. Rd. K, V02 <br /> Siren MI 54872 I <br /> Burnet(County Office of Zoning Administrator ( m o <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 '� y <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m c <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 Wiscon <br /> 71f�1X T`� �• � P�aIJYT a o J <br /> OW R(Plr Prin j Contractor or Surveyor or Agent <br /> �TLL x <br /> m <br /> Addre s Address <br /> City,State,Zip Code City, State,Zip Code <br /> Telephone Telephone xt <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit n o <br /> Privy Subdivision 0 <br /> N <br /> mss? o^ O^ CG" <br /> Structure Use: <br /> (family home/cabin,garage,addition,etc.) o -Oo <br /> 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). c <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. ("n o <br /> 4. Shaw dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building to lake, <br /> 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 /> 6. o <br /> PLOT PLAN 3 <br /> c N <br /> c <br /> Z <br /> o a a <br /> p 5 P q <br /> e <br /> ( J <br /> N <br /> m <br /> 0 <br /> 0 <br /> m/h <br /> O <br /> m <br /> O <br /> 2 <br /> 7D o Z <br /> m c� .w00 accm <br /> o o-< om oa= <br /> o am =am <br /> 5. 01cyo'�3 <br /> w `20mmo <br /> 0 <br /> z <br /> o � <br /> m <br /> C> <br /> o �; C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m <br /> PP (including Yaccompanying ) recognize n ' <br /> information contained in this application includin an schedule and I further declare that I that <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a o <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing m <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized a <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> yj(� D <br /> SIGN HERE � <br /> E turep ownor 7.b ming contractor) r (date) o' [ o <br /> ZONING ADMINISTRATOR <br /> v T <br /> LL NNOIV��Nm <br /> TOWNSHIP PERMITS AY BE REQUIRED <br /> 0000000rA <br />