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imett County 7410 Co. Rd. K, 1102, Siren, WI 54872 Office of Zoning Administrator d ! o 0 <br /> APPLICATION FOR — LAND USE — PERMITS '- B <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 c <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula. 3 $ <br /> tions of the State of Wisconsin. - <br /> 0 <br /> io 01 <br /> ,11912E5 L 4" &Agg,y M I7A aar4 <br /> o <br /> OWNER(Please Print) Contractor or Surveyor or Agent a <br /> _823 O7__r Va 4116 d <br /> Address Address I <br /> 7r ;Ono L, /f7A/. .5s107 <br /> City,State,Zip Code City,State,Zip Code r� <br /> fc i2) 227 <br /> 6874�, <br /> Telephone Telephone <br /> Permit(s)Applied for: �. <br /> New Building ° <br /> � Filling/Grading <br /> Addition Moving p <br /> Sanitary Camping Unit O <br /> 0 <br /> Privy Subdivision 0 •'�- <br /> m r <br /> ,` / c <br /> Structure Use: FUEL /VA00yNEO <br /> (family home/cabin,garage,addition,etc.) 0 0 <br /> a <br /> Directions for plot plan drawing: 71. <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. o <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 /> 6. 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. <br /> n <br /> PLOT PLAN i, 3 <br /> II ' Y/uf .SIC. inn o a <br /> I,I d o <br /> It <br /> fi 1 I l A <br /> l�.di C. <br /> Uj <br /> 5�C <br /> ID <br /> F��� , I�►�� 1N1� cV� \� C <br /> ,''u w JOA C� a <br /> C�-y6 Cn <br /> m 9-) <br /> v 41 <br /> N o ' o <br /> x, C) <br /> p eo <br /> 1150 <br /> o J <br /> � yru.CtwtiLrnru.,�` , <br /> C`3 <br /> 4 4 iz<> > nn� m <br /> m a� am ^;aS <br /> N m O J b <br /> m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of my <br /> PP f 9 Y ) Y <br /> knowledge and belief it is true,correct and complete. o <br /> acknowledge that I am responsible for the detail and accuracy of all ^: m <br /> information contained in this application(including any accompanying schedule)and I furtherdeclare that I recognize that i ' ; p <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 <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 /> m <br /> (� �w . <br /> SIGN HEREy d' [ <br /> nat re of ner or ui ing contractor) (date) xJ <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMIT=AY REQUIRED ""O N o o m m <br /> 0000000In <br />