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o;o <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator co w -0o 0 <br /> APPLICATION FOR - LAND USE - PERMITS3 <br /> 0 <br /> TO THE•ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 6 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. <br /> J <br /> OWN <br /> e Print) Contrfctor or Surveyor or Agent o <br /> ( trif m <br /> Ad re I I Address _ <br /> Citate; Ip C_od City, Ste,Zip Code' <br /> Te hon TelT�one— W <br /> i <br /> Emergencre No. and Road Name _t kj <br /> Le <br /> ggal Description (as indicated on tax statement) o <br /> �r�t 3� C�M� VOl• f� /?S . �j �,��Tf Cty, �-� _l:, l vl/w/yl -7 <br /> Permit(s)Applied for: 0 0 <br /> Dwelling \ --��l Addition Filling/Grading Camping Unit o = <br /> Acce g F � <br /> CCS}� Z v <br /> Accessory Building Sanitary Privy Subdivision P <br /> Garage <br /> `t <br /> Structure Use: )L 90A)�f �� - �" � � �'� .R � , f / _ 0r <br /> (family home/cabin, garage, addition, etc.) S- ° <br /> 1A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: O <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). 0 <br /> 3 <br /> 3. Show the location of any lake or flowage- if within 1000 ft. and the location of any river or stream- if within � P u, <br /> 300 ft. Z i <br /> P n <br /> 4. Show dimensions in I eat of the I ollowing:(a) building to all lot lines,(b)building to center line of road, (c)building <br /> to lake, river or stream, if applicable. Ifl o <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C <br /> dated by the owner. fA rj <br /> PLOT PLAN C <br /> SUI` <br /> .,V �1 - <br /> s <br /> der, <br /> f 1�1 [ <br /> �° l5 , <br /> S'Gr /Orb (C l <br /> % 9 0 <br /> 0 U1r Dn <br /> L <br /> Z12 <br /> m .2 M <br /> P Fes : y M <br /> — m <br /> � [ <br /> on O <br /> ( � g c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best ofmy know)7N o i a <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs%.) }�' O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- v $ 'm <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 0 1 g A g <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 couyly officials charged with administering county ordinances or other authorized person to have N <br /> access to the above deribed premises at any reasonable time for the purpose of inspection. m 8 <br /> 3 n <br /> J j m <br /> SIGN HERE <br /> (si a re of ow wilding contractor) + ( .ate) O o }, <br /> ZONING ADMINISTRATOR µ s <br /> NNR�I/ g <br /> TOWNSHIP PERMITS MAY BE REdl 663 1990 w " o " <br /> V N O <br />