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f c )' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator c T o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and Q is <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m a <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 a <br /> tions of the State of Wisconsin. o <br /> CAV I- F. STR 03 <br /> OWNERPlease Print)) Contractor or Surveyor or Agent O a F <br /> iNSMCAli dR1AG `J� P.IV4" m <br /> Address <br /> nCOACto / Uj1 S , 5 �/j^a Address m rl <br /> City,State,Z�Ip Code City,State,Zip Code <br /> Telephone W60 L4d Telephone <br /> NdR7(hS00I6 �RrvK6 F1Qeki Iltol7 <br /> Emergency/Fire No. and Road Name _ <br /> 3ENSCNS {-/SKr $tjol?£ DIV, uf= WdoDLAW Loth Lor '7 &K I <br /> Legal Description(as indicated on tax statement) <br /> 0 <br /> Permit(s)Applied for. <br /> New Building Sanitary Filling/Grading Camping Unit 3 <br /> Addition Privy Moving Subdivision e <br /> v <br /> Structure Use:(;/4RA64i — 57 -46 - /tulle[: S4'9_&P NG1/1✓iA1& SARcE o v <br /> (family home/cabin,garage,addition,etc.) z <br /> Directions for plot plan drawing: <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North(N). c <br /> 2. Show the location of the well(W),septic tank(ST),and drainfield(DF). <br /> 3. Show the location of any lake or flowage-if within 1000 ft. and the location of any river or stream-if within 300 ft. 'tl <br /> 4. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building to lake, 0 <br /> river or stream,If applicable. <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and dated by <br /> the owner. <br /> 3 �"1 <br /> PLOT PLAN <br /> o a� <br /> lug$-, M T <br /> ,1sD G1 C <br /> M d <br /> L : <br /> ) � I <br /> a s,-a Ry o <br /> 0 r Nv_B. 0 <br /> (u£lL <br /> is Slfhk£v <br /> a�1 0 <br /> w rf-li N�16N1b oQ Rnll� � �- <br /> �-ec9fc`il /18nurSSFctz 5(c1 � , <br /> o � � <br /> S? uwy <br /> /=4Sf- OF Lr i-iAi i rt1 <br /> uWa / IYDIC4-tL_:5 wwtRc <br /> PAY J.'E46 <br /> 1-R U N til a Lucy L E 1 �o <br /> is .4trActiao to up 14dA4a. 38' K1 <br /> 351 �pU Sc <br /> PffR S 01+/ s H R IR r N& U;e.L,- 15 <br /> Topp f#uDaKSoN <br /> 35' <br /> m c � � ra-•m <br /> m a� »am „nom <br /> 51102ir LINE "►51 E2 i '00 <br /> 70 <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs- m� <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- �; yy!! a E M <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I i 15 <Nn E <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- $a $E <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 /> SIGN HERE / `� �' ` '• `;'`� `n" <br /> net re of owner ildin contracto w $ <br /> ( g r) (date) r l� '• o E <br /> ZONING ADMINISTRATOR - n' ' g` <br /> MH+V1(NMN�I <br /> TOWNSHIP P RMITS MAY BE REQUIRED .. .5"99Sm <br /> 88$8$88cmn <br />