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Burnett County 7410 Co. Rd. K, #102, Siren, MI 54872 Office of Zoning Administrator ma 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 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 the State of Wisconsin. » p <br /> d <br /> o <br /> OWNER(Please Print) Contr ctor / rvey. or A en�(__) n ? <br /> m <br /> Address <br /> City,State,Zip Code City,State,Zip Coe li <br /> Telephone Telephone <br /> I ;-L <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving / o <br /> Sanitary Camping Unit n c> <br /> 0 <br /> Privy Subdivision -t. <br /> r <br /> E; <br /> Structure Use: <br /> (family home/cabin, garage,addition,etc.) o <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). <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. 0 <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 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. 6. Provide legal land description. 0 <br /> 0 <br /> PLOT PLAN 3 <br /> a N <br /> Z Q <br /> o a <br /> J <- <br /> � w <br /> o' <br /> rn <br /> a <br /> N <br /> _o <br /> O <br /> T <br /> .n N <br /> fi Z <br /> i Z <br /> a <br /> � m <br /> m n< - nm »ate <br /> v < <br /> 0cyo='3 <br /> : , O J`0 <br /> N <br /> m <br /> b: <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 ) g p A <br /> information contained in this applicationan schedule and I further declare that I reco nize that ("`: > : O <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 y <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized n <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> N <br /> SIGN HERE <br /> (s' lure of owner uildin contractor) (date) o o <br /> ZONING ADMINISTRATOR <br /> m <br /> TOWNSHIP PERMITS MAY BE EQUIRED <br /> ut ut v,o 0 o v,m <br /> 0000000 <br /> ,. o000000fn <br />