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rf , i <br /> Burnett County 7410 Co. Rd. K, #102, Siren, RI 54872 Office of Zoning Administrator iu ' o Z <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 N <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 a <br /> tions of the State of Wisconsin. // <br /> lIUA�SO/J OR , P-P� air /7 lesaA = O <br /> OWN)VIPleasePrint) (JO I n Con cto4.Rr Surveyor or Agent o <br /> TT 1 m <br /> Address A dress �j <br /> L lLt, err �i�f �c ZL� Z alts// Gli/ L` L/ S� <br /> City,State,Zip Code CState,Zip 9ode �I <br /> '7� s - G <br /> Telephone Telephone , <br /> Permit(s)Applied for: _ <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit 0 <br /> 0 <br /> Privy Subdivision 0 ,<.- <br /> w � <br /> Structure use: <br /> Salk/ O�IU <br /> (family h melcabin, garage, addition,etc.) o 'o <br /> a <br /> Directions for plot plan drawing: _ <br /> m <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North(N). C� <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, <br /> 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. 6. Provide legal description. O <br /> PLOT PLAN 3 <br /> 'D y <br /> c <br /> o � n <br /> W N <br /> 0 <br /> Y <br /> � 1 <br /> av <br /> I <br /> N <br /> 0 <br /> o <br /> I <br /> 0 <br /> v O <br /> Z <br /> p <br /> f <br /> M c-a r tDi nco-0 <br /> n o-< o Ana—m <br /> : 2 fD o MQ <br /> o <br /> O : fD <br /> 2 <br /> m <br /> v : HiQ <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m <br /> information contained in this application(including an accompanyingschedule and I further declare that I reco nine that A <br /> PP ( 9 Y ) 9 O <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a o <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized a <br /> person to have access t9 the abov describe premises at any reasonable time for the purpose of inspection. <br /> m <br /> m <br /> SIGN HERE d' <br /> ( ' ature of owner building contractor) (date) N <br /> ZONING ADMINISTRATOR o o <br /> QN N N N T <br /> TOWNSHIP PERMITS MAY BE REQUIRED /�N N 000,m <br /> Voo 0000 <br /> oo�0000 Vl <br />