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� l �Uryi f <br /> 3urnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d o o <br /> APPLICATION FOR — LAND USE — PERMITS . <br /> o <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- N C dO <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula. 3 0- If <br /> 01 <br /> tions of the St a of Wisconsin. m 'o p <br /> Nolb � <br /> OWNER(Please Print) Contractor or Surveyor or Agent <br /> U ` OR ZAW,E. e ) AC ,�c <br /> Address Address <br /> Ch�mpi�w MAJ SS-3)4 i <br /> City,State,Zip Code City, State,Zip Code <br /> j( iz - ua� ia3 s •- <br /> Telephone Telephone N <br /> ,?V719 �vf Ro/ya� ®f� � OSI1ta ,�'taxa� om <br /> Emergency/Fire No. and Road Name 141&J H i /O/p )y SON® 7r 3,B� �P 1 S A[J1Ea. 60 <br /> Ptlll"t 39• ts• 011, 02500 toll z 05Al y& P22 ifrw svut Aa7' .3,� � <br /> Legal Description (as indicated of tax statement) o <br /> Permit(s)Applied for: <br /> lr o fi <br /> New Building Sanitary Filling/Grading Camping Unit m fl <br /> Addition Privy Moving Subdivision o <br /> S�D1A � E -7DY Pt1"SONs 1 7t-1 i2e, t peI4 <br /> Structure Use: T <br /> (family home/cabin, garage,type of addition,etc.) <br /> Directions for plot plan drawing: V1 V <br /> 1.Show the location and size of all existing buildings(EB)and all new buildings(NB) and indicate North (N). (� O <br /> 2.Show the location of the well (W) septic tank(ST),and drainfield (DF). N <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. V1 <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 /> o M <br /> 3 <br /> PLOT PLAN m <br /> Z c <br /> O V ,n <br /> IN a 1/ <br /> to <br /> y' rn <br /> s! �JtC`ss rCA rr (1 <br /> o <br /> 41 <br /> b C a' <br /> N oQ y <br /> 0 <br /> o <br /> loll <br /> NE �i J S <br /> uo)a)wy o <br /> TANK wF)t <br /> F�s)st/af L '�)� <br /> V4 <br /> Z <br /> � y <br /> B% 8 ' osdFrwm5v���) <br /> ugwAll <br /> , )3 O <br /> H 69 N us- � I �tL <br /> to tnvmr DDtPy <br /> a <br /> 'Sm a� =a M =FL = <br /> a <_' <br /> 2 <br /> Cyon 3 <br /> 1 lV^O N `2 N O Mn <br /> N <br /> Z O: –1 <br /> m <br /> »,'o C <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 informs- 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 determining whether to issue a permit. I a <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- X <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 /> m N; <br /> ure ner orb 'ng tractor) — (date) I o n o <br /> g n <br /> 0 N N O N R <br /> TOWNSHIP PERMITS MAY BE REQUIRED ° <br /> 2F m <br /> 0 0 0 0 0 0 <br /> L? <br /> J 0000 oo¢eW <br /> O <br /> d <br />