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0�) Cowl <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 /> 1.2 0- <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and y <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- 3 n <br /> tions of the State of Wisconsin. o <br /> N d <br /> C <br /> OWNF,q(Please Prins) Contractor or Sury or Agent <br /> /l r <br /> Adds 0CLYkSON Address <br /> C <br /> City, tate,Zip Code City, State, Zip Code (b <br /> d � <br /> Telephone Telephone <br /> Emergeng-y17 ��nd Road NIP, <br /> 01 0� (07Z`CSON �(JUtN r <br /> Legal Description(as indicated on tax statement) o <br /> Permit(s)Applied for: <br /> 0 <br /> New Building Sanitary Filling/Grading Camping Unit m <br /> Addition — Privy �—^ I Moving Subdivision o <br /> ©we M. � TµM / Z a <br /> Structure Use: 0 1 <br /> (family homelca in, garage, type of addition, etc.) <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). o <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 u <br /> o <br /> PLOT PLAN F m <br /> Z C <br /> ° a <br /> 5. <br /> - Sem <br /> �P/'r� f H-• �J3l)r SL{'h/1/kl'rpp ? <br /> m <br /> 0 <br /> Q <br /> C <br /> N <br /> O <br /> m <br /> O <br /> n W <br /> 7p <br /> 1 Z <br /> M c <br /> M.N ori 0aa m <br /> o ac 3G o a-. <br /> M n - am »n 3D <br /> D G m C 00 m 3 <br /> N Z N O J 0 <br /> O m z <br /> �� . <br /> m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o: y <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- y Ao; I m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in det mining whether to issue a permit. I (A <br /> further accept all liability which may be a result of the County of Burnett relying on th' nformation I am providing in this ap- <br /> plication. I agree to permit my officials charged with administering county ordin n s or other authorized person to have 'ij <br /> �, <br /> access to the above rib premises at any reasons ime for the purpose i pection. <br /> /l m <br /> SIGN HERE 'z_�v �.no <br /> (si re alrowner y g ractor) ,% (date) o v o <br /> :nb <br /> ZONING ADMINISTRATORomno <br /> TOWNSHIP PE41TS MAY BE REQUIRED CN N a N m <br /> U N T P O O <br /> 0000 oo?'Ul <br />