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Bumett County 7410 Co. Rd. K, #102, Siren, Ml 54872 Office of Zoning Administrator d o Z <br /> APPLICATION FOR — LAND USE — PERMITS d 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 a <br /> tions of a State_gLWis,Consin. 7 <br /> c [� S0 L F-S -4 /1 7c L r _S <br /> OWNER(Please Print) Contractor or Surveyor or Agent o O <br /> Address Address <br /> L i L k �'Vl S1 n�f1 <br /> City/,/State,Zip Code City,State,Zip Code I <br /> Telephone Telephone <br /> Permit(s)Applied for. <br /> New Building Filling/Grading 7 <br /> Addition Moving p <br /> Sanitary Camping Unit 0 G1 T, <br /> o <br /> Privy Subdivision 0 <br /> m � <br /> Structure Use: <br /> M <br /> o <br /> (family homelcabin, garage,addition,etc.) o 'o <br /> 0 <br /> `° IV1`II <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). <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 1 <br /> theowner. 6. Provide legal land description. 0 W <br /> PLOT PLAN 3 <br /> T, y <br /> MomZ <br /> � y <br /> P a <br /> t <br /> 0 <br /> M►�� +o / u�P, J )°� lad <br /> � o <br /> I <br /> e� <br /> � 9 s <br /> e <br /> 0 <br /> 0 <br /> A01 N <br /> 'V Z <br /> O <br /> Id <br /> I Z <br /> 0 (n v r D a -0rn <br /> ar - n aa9 <br /> v = d c 0='3 <br /> �-V IIJUS It'iT (11.i � 11 i' 'I <br /> 11� r»11�1 ��'� 13�J13 -i- ��� �: - m m <br /> v,: n 0 <br /> o f t c C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 0: m <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 furtherdeclare that I recognize that <br /> PP f 9 Y ) 9 m <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a Ao <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 to the above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> SIGN HERE <br /> (sign ure ner or>4cjpKg contractor) (date) i <br /> i <br /> ZONING ADMINISTRATOR <br /> w <br /> m <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N. N o N m <br /> oorm/7 <br />