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on cofy) P <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ,� 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 andm <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. o <br /> OWNER(Please Print) Contractor or S_uCrveyy6r or Agent n r F <br /> 7-7 <br /> Address / Address <br /> or, 6Gt.n .n C> <br /> City,State,Zip Code City,State,Zip Code 1 <br /> Telephone Telephone (� <br /> Emergency/Fire No.and Road Name <br /> 2 /.5-77 Pe" 54 �d >E�� CSec Iz Nf NkJ l 1 DO <br /> Legal Rscri ption(as indicated on'tax statement) o <br /> Permit(s)Applied for. n 0 <br /> o <br /> New Building Sanitary Filling/Grading Camping Unit 0 .`.- <br /> W <br /> Addition �X� Privy Moving Subdivision g 2 <br /> Structure Use: ho-kyu +✓�" �!N'�^"� <br /> z o <br /> o <br /> (family homelcabin, garaldirfype of addition, etc.) m <br /> I <br /> Directions for plot plan drawing: <br /> 1.Show the location and size of all existing buildings(EB) and all new buildings(NS)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. <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. n <br /> 0 <br /> 3 <br /> PLOT PLAN c N <br /> Z a <br /> o n <br /> f 9J o <br /> A J Z <br /> o <br /> 0 0 <br /> J <br /> ` N <br /> R / <br /> Gam\ J <br /> 15 <br /> 3 U <br /> I <br /> Z <br /> �U I <br /> fs °/vY � <br /> C M.0 w 0 a cm m <br /> a< 3J0n- m <br /> < <br /> <' C: 60 <br /> o J l0 <br /> Z o: N..Z <br /> — , u: m <br /> moo: -.�o a: C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- G E7: <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- C_i m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. A <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I ya <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 reasonable time for the purpose of inspection. ^� <br /> T N; <br /> SIGN HERE d�2�Ly�L� / Z�J'7 � j/�`3/ 90 e' n'o <br /> (sig ur of owner or blodog contractor) (date) <br /> ll^^ pb iDp <br /> V1: O:J : ftp <br /> ZONING ADMINISTRATOR <br /> C ;u �,u T <br /> C'N N O -9 m <br /> TOWNSHIP PERMI S MAY BE REQUIRED Npp <br /> oo oo�o fmn <br />