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on Com-P <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d -V0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. :E TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m 00 <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 the State of Wisconsin. w o <br /> moi P, it Pr L SQ—H0L. Z ►= <br /> � o <br /> OWNER(Please Print) Contractor or Surveyor or Agent n F <br /> 319'.L wiSTE06- h! D4ufl <br /> d ress "� Address <br /> City,State,Zip Code ^ 30117 <br /> City,State,Zip Code <br /> LA <br /> vV <br /> Telephone' +t• < Telephone <br /> �CL IS_ CU 5'0 OrEOa 0 i <br /> Emergency/Fire Noy�and Road Name ,(] <br /> NgszJw.. Y��Pa.QM t�t9re-O �"tOw�p,$' ADO L6 `' ` <br /> Legal Description (as indicated on tax statement) o <br /> Permit(s)Applied for: n <br /> 0 <br /> New Building Sanitary Filling/Grading Camping Unit <br /> m r <br /> Addition �/� Privy //�� Moving Subdivision <br /> n/� 0— <br /> Q <br /> Structure Use: /4 h 0 CshJ l.A 91 ri CD rl LI V //��I o e- /� 0a/%-X T Oe Z a <br /> o <br /> (family home/cabin, 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). 5 <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. p <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. i o <br /> PLOT PLAN W p.N P Z c <br /> o Q <br /> 0 <br /> � <br /> kip o QD <br /> t?w `7 <br /> 0 <br /> N <br /> �� .Pont► AQoiT0^4 i0 V' <br /> I � 0 <br /> �A61A; ¢ <br /> yo 3 0 S1 .0 <br /> r bt Po <br /> 'f Sfr � t <br /> 66 d, <br /> ve <br /> i <br /> i �7 (nvmr DDW � <br /> M0 c _.mon 0nc m <br /> m n� .:nm - nom <br /> o < °1cmo=' 3 <br /> Z m f ? � 0 0 m <br /> o o <br /> W :N: M <br /> % m <br /> 0 <br /> O: <br /> O: <br /> I declar th t this plication(including any accompanying schedule)has been examined by me and to the best of my knowl- 0o: y <br /> edge and b lief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa. a 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 n ; <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 reas nable time for the purpose of inspection. <br /> - in <br /> m <br /> SIGN HERE <br /> PtZIL J9 070 <br /> no; <br /> vE�i ami+ <br /> VES <br /> i nature of owner ld' co r (date) O roTOWNS P PERMITS MAY BE REQUIRED o m jlIllo 'V <br />