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Burnett County 7410 Co. Rd. K, #102, Siren, WI 54872 Office of Zoning Administrator f� � o 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 and 'z 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- <br /> tions of the State of Wisconsin. o C <br /> / N d <br /> W1,C'9,4 g O <br /> sWNE (Please Print) V Contractor or Surveyor or Agent E <br /> / �� /6 r-9 <br /> Address` -5 / /-A A / � �7 a 75 Address <br /> City,State,Zip CodeCity,State,Zip Code <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition y�� 6L. �> Moving p <br /> Sanitary Camping Unit <br /> 0 <br /> Privy �i ,iJ - Subdivision 0 <br /> �° y <br /> Structure Use: ( i1 W ` VI l(JLJ I n o <br /> L <br /> (family hom cabi garag ,addition,etc.) o 0 <br /> D <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). <br /> 2. Show the location of the well(W) septic tank(ST),and drainfield(DF). i- <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 lake, Q <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. 6. Provide legal land description. <br /> PLOT PLAN • o <br /> /Ilt' 3 <br /> o y <br /> Z c <br /> N <br /> 77 <br /> P <br /> t� D <br /> cz n L <br /> y {� <br /> .2 <br /> 6 <br /> i r' <br /> 3 <br /> f; <br /> 32 �� <br /> b <br /> �7� � N I <br /> o \ <br /> O <br /> D <br /> O <br /> Sem , <br /> ]1 N17 U)rD � <br /> n Q< > > oaArt <br /> a� <br /> v <' cmo`�3 <br /> - O ME <br /> O ? �Z <br /> In <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of my c I ! C <br /> PP ( 9 Y ) y `o ; p <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all _ n m <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that 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 a ove described premises at any easonable time for the purpose of inspection. <br /> T <br /> � % N <br /> SIGN HERE <br /> ign re <br /> of own bulldlinfI contract (date) E E <br /> ZONING ADMINISTRATO $ ` o <br /> E o <br /> TOWNSHIP P61RMITS MAY BF, REQUIRED <br /> e, 0000 <br /> �110 e oau«fd,. Below ©t+w/s, L)� 1.f3le <br />