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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w --0 <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and z m <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 M r A' <br /> tio2s of the State of fWWigco <br /> Y�-(iy7.Cn l(-`��l <br /> CC)J N m <br /> N v <br /> ME(Please Prim t Contractor or Surveyor or Agent n f <br /> d <br /> Addr sq S Address m 1 <br /> City,State,,Zip <br /> I —RFs Code (a -S( J (10lJ1 City,State,Zip Code <br /> �i <br /> Telephone Telephone <br /> f1 <br /> Emergency/Fire No.and Road Name <br /> Legal Description(as indicated on tax statement) <br /> 0 <br /> Permit(s)Applied for: <br /> New Building Sanitary Filling/Grading Camping Unit <br /> Addition Privy Moving Subdivision o <br /> v <br /> Structure Use: 0 90 <br /> (family home/cabin, garage,addition,etc.) m <br /> Directions for plot plan drawing: <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NS)and indicate North (N). r <br /> 2. Show the location of the well(W),septic tank(ST),and drainfield(DF). <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 lake, /t <br /> river or stream, if applicable. 9 �J <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and dated by O <br /> the owner. 00 <br /> PLOT PLAN on -' m <br /> on Z c <br /> m y <br /> c S <br /> 0 <br /> INQ <br /> o� m <br /> m <br /> V <br /> „ Z <br /> (Avm�>> <br /> a '> > oa c m <br /> SD. a: -am nMM <br /> Z 00 no <br /> o <br /> �n 0 <br /> PP (including Yaccompanying ) y ,CS w c C <br /> 1 declare that this application includin an schedule has been examined b me and to the best of my knowl- O0 : . <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 o �? <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. O~ <br /> �7 N y [ <br /> V N 9NF: <br /> SIGN HERE_ / '� <br /> �m O; <br /> (signature of owner or uilding contractor) ^ (date) <br /> ZONING ADMINISTRATOR <br /> S <br /> NNOi,-n <br /> TOWNSHIP PERMITS MAY REOUIR u u v m o 0 o m <br /> 8;-0888,080 <br />