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v=' 4 z <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator „ 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 £ <br /> z <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m o <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- 3 a <br /> tions of the State of Wisconsin. — o <br /> Marx t3iIe�/ c .,C y <br /> OWNER Please Print n O <br /> ( `) ' Contractor or Surveyor or Agent o <br /> 24 WT y_ p <br /> Adtlress <br /> Address m <br /> Ut <br /> City, State,Zip Code City, State,Zip Code <br /> tL <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name <br /> Lot 4 . &ee+-Fid Svr.ic� ^"a0 Vol Par'p � a� �anrcel /mnaCQa flvSo <br /> Legal Description(as indicated on tax statement) f^4 <br /> Permits)Applied for: ��!! <br /> New Building Sanitary Filling/G rading.L, Camping Unit 3 0 <br /> AdditionI X Privy Movin9.bur t'9e� Subdivision m m <br /> `ll g o <br /> Struc ure Use: Orr^GrY �oG45ck r�v(� Cct r^'�r�r ]t ✓ht- pyy Mtni rr,6tr� o 0 <br /> / a ily home/cabin, garage, type dddition, etc. <br /> CPc [C To k)Q Scre� D <br /> Directio 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). ho v,.e 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, buil for,etc.,the plans must be signed and dated by <br /> the owner. , O <br /> 0 <br /> PLOT PLA # 3 <br /> a <br /> 0 c <br /> l Ory n <br /> P /v O <br /> `C (J <br /> U <br /> 1 <br /> 4t)r�r�hcw�-� C.gke J <br /> � J <br /> ` o �. <br /> J <br /> b eoy <br /> 19 <br /> new cVeck <br /> I �: !off'/O Cg <br /> z <br /> ` 1 � <br /> i <br /> Ltir.l.aw� l.uK� j 3o/wc�e gr4cll,.� <br /> i <br /> M rn-D m r D y <br /> 2. <br /> mC o33 <br /> Lq <br /> f J ^ YA; <br /> Y. :N m <br /> trl o t- :• : O <br /> �o o: <br /> declare that this application(including any acco anying s hedul as been examined by me and to the best of my m <br /> know) <br /> edge and belief it is true,correct and complete. I ac owledg h am responsible for the detail and accuracy of all infor <br /> tion contained in this application(including any acco nyi chedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the Count Burnett Wisconsin in determining whether to issue a permit. I <br /> rmation I am providi <br /> further accept all liability which may be a result of the County of Burnett relying on this inin this ap- <br /> fong <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. "I <br /> w; <br /> N N. <br /> SIGN HERE <br /> m :o: <br /> *Ali <br /> ng contractor) 3— <br /> . <br /> a <br /> ZONING ADMINISTRATOR I' "�Li� It , _ ".------, o:m : n o <br /> _ - F <br /> 10 1 <br /> TOWRMITS MAY BE REQUIRED �NNN ok m <br /> �I .;, MAY 30 !- 1 ��L0000 o <br /> l0000 o fn <br /> I __ <br />