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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> z s _ <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- <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 a p0 <br /> tions of the State of Wisconsin. // m a <br /> j&1_Zi4 nl �Q.rtLo L .UOn7h Wil, o ,BLDs .�,✓e. o D <br /> OWN galeas Prin �/ Contractor or Surveyor or Agent a f <br /> /��,�ih'/ d�� .+�� �/S.� .lorr�w;�� ��t.rs-e c•, d S <br /> Ad rens Address J <br /> �A�Al& L «, ,� s���3a l <br /> City State,Zip Code Ij <br /> City, State,Zip Cod <br /> Telephone Telephone <br /> 171.0' 7,1 <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as indicated on tax statement) p <br /> Permit(s)Applied for: <br /> 0 <br /> New Building SanitaryFilling/Grading Camping Unit - 3 <br /> m <br /> Addition Privy Moving Subdivision g <br /> v ( 4 <br /> Structure Use: z g v4 <br /> (family home/cabin, garage, type of addition, etc.) o <br /> Directions for plot plan drawing: <br /> Y <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. N <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. n <br /> 0 <br /> PLOT PLAN a <br /> rn <br /> Z c <br /> o a <br /> 1 m <br /> IC 0 <br /> N a' <br /> jj <br /> zgBrN(o v" <br /> Mn1 <br /> J \ g �� N <br /> O � <br /> G <br /> (V <br /> c2 y8, Y.Si <br /> mc m r n n c -0 <br /> 0 v< JJOa-. m <br /> m arc - a0 ^;nM <br /> C 00 <br /> y : � N O JV] <br /> O J M <br /> � Ea <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best o 0 <br /> I my knowl- !J 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- ' " 'o E 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- J <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. t",, <br /> T ON[ <br /> pt <br /> SIGN HERE �- J-40 <br /> n <br /> ,y <br /> ( ' net re of ownilcfing contractor) (date) [ rop <br /> 00 <br /> ZONING ADMINISTRATOR <br /> IleT <br /> N N O N m <br /> TOWNSHIP PERMITS MAY BE REQUIRED ° mojo" m <br /> o$0000q Ul <br />