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BurnettCounty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator u 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> d o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <br /> N <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 a <br /> tions of the State of Wisconsin. o <br /> m w <br /> St nuev\ L- 0Isyr� L .P. DuneaviConst, <br /> OWNER (Please Print) Co tractor or Surveyor or Agent o (� F <br /> �0 SPer�u AL) � CJX �Sy <br /> Ad ess 0 Address � i <br /> � Klu41 ParkI lhn , 5Sy43 11,11:bst U11T, Syg"93 <br /> City, State,Zip C e T City,State,Zip Code � _ ) O <br /> lD Imo- S-W - U(,o 3Y PrA <br /> Telephone --7 ,Ikphone <br /> T <br /> aj 1) 0 S Lk) / !o % <br /> Emergencire No. and Road Name <br /> C� y/FmrneotLotS S,ect.0„ 33 11 Tow n -kI L-I Notfh Ran <br /> Legal Description (as indicated on tax statement) 1(p w6np- ) 13LArn eij C4u • W is. Pctreef N 0 • I 4 <br /> Permit(s)Applied for: n <br /> 0 <br /> New Building Sanitary Filling/Grading Camping Unit 0 .`.- <br /> W <br /> Addition Privy Moving Subdivision 0 0 <br /> Structure Use: araae_ 13 u '1IeflinGi '— � (-QyP o 0 <br /> (family home/cabin, arage, type of aaddition,etc.) <br /> r <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. o <br /> 0 <br /> 3 <br /> PLOT PLAN / /Z•8o/ o y <br /> t Z <br /> P n <br /> ,A10 40 h 'yk iiii mark N: <br /> z�- T a°�to so . lot <br /> -1a '�o lYmr la4 lvnP 72/ � y EB �° rile. w <br /> Sf 3lv w <br /> 150' bef eeA � tcistlny <br /> as i n uvtc0 +t L` o D <br /> 3C) g4ockc✓� lnurld:AS m <br /> o <br /> n <br /> -]& "J() Mo. 1o4 line x -710' —� N3 p to Ste ' <br /> log- Iifl_e) <br /> CIE-K;st; n5 dab ; n 1Sv161CZ <br /> Q eve.•eAt <br /> -cw bC,(,_Idirrsw : ll <br /> cvx Cvtt 514b) 50� to 1 of <br /> U) <br /> C 1( �:y s' ;h b ae � a /(C APR 12 IDAO <br /> a41o ,n, f 4 nnm � <br /> Cti11cw bull�lYlS I$ IQQ� T ate =' 0an9 <br /> fQ nF• G16� M,.0 <br /> o =1 <br /> $ �.€oi <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- no :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- m <br /> tion contained in this application(including any accompanying schedule)and I furtherdeclare that I recognize that this infor- 00 <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 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. v: <br /> T fA <br /> SIGN HERE JU "`r"' `i" v � • V___ ” " cf o <br /> (sign re owner or b g contractor) I (date) <br /> ZONING ADMINISTRATOR <br /> T <br /> TOWNSHIP PERMITS MAY BE REQUIRED �oorm <br /> 000000 m <br />