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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office ofZonin Administ�r ,e, 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS d <br /> 3 £ <br /> z o <br /> TC THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 0 <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 0. <br /> tionsof the State of Wisconsin. o <br /> r: )�y c4 e.9 e T— <br /> OWNER(Please Print), Contractor or Surveyor or Agent o. E <br /> «�ia � �Soh st iU <br /> Addre s i Address <br /> ,I/ u al Z r, W. <br /> City,State,Zip Code City, State,Zip Code r <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name 0 <br /> Legal Description (as indicated on tax statement) v <br /> Permit(s)Applied for: 0 G> <br /> o <br /> New Building Sanitary Filling/Grading Camping Unit 0 <br /> w r <br /> Addition Privy Moving Subdivision $ R <br /> v <br /> Structure Use: o 0 <br /> (family home/cabin, garage, type of addition,etc.) <br /> 3 8_41L&- <br /> Directions for plot plan drawing: ��11 <br /> 1.Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North (N). 1' <br /> 2.Show the location of the well (W),septic tank(ST), and drainfield (DF). l�j\ <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. 0 <br /> 0 <br /> PLOT PLAN 3 <br /> �4 <br /> o <br /> ��j- /�6 �rnmlxsee tiaPJwj 0 <br /> 0 <br /> ICU I } 1�7`_ <br /> 0 <br /> } - - — — o <br /> ChC <br /> � o <br /> _ <br /> `r <br /> Iva+e _ - <br /> X�rC� l��� <br /> t � m cnm cn DDm y <br /> U / m, o. , o. m n ; <br /> LD < ° C m o S <br /> m � w p =,p <br /> 18'wi�e— re o 50 ,z : 1 <br /> P ` N: : M <br /> /0'- bOffru�m e�f�acf� frd�t Lalee isoK� t bf ' a m <br /> 0, : O <br /> I declare that this application(including any accompanying schedule)has been examined by me an to the best of my knowl- C o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- a o 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. 1 A f n i I <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 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 <br /> SIGN HERE <br /> ! (si re of owner tiding contra r) Bio. <br /> (date) o; c <br /> ✓l <br /> ZONING ADMINISTRATOR —/��1'l� : . oo' <br /> TOWNSHIP PERMITS MAY BE REQUIRED �" oo� m <br /> 00 000 Uf <br />