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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. — <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. H m <br /> Brian Weidendonj <br /> O jVER(PleaV3 PrContractorContractor or Surveyor or Agent o 1 <br /> KK-tt H 77 <br /> A069R, MN 55051 Address <br /> City, State,Zip Code City, State,Zip Code U'o <br /> (612) 679-5218 I — <br /> Telephone Telephone I <br /> -9 <br /> Enter ency/Fire No. and Road Name <br /> Lot 1 CSM Vol. 13 Pg. 154, Sec. 24, T41N, R17W, Town of, Swine <br /> Legal Description (as Indicated on tax statement) <br /> C) <br /> 0 <br /> Permit(s) Applied for: 0 '- <br /> Dwelling Addition Filling/Grading Camping Unit o <br /> $7 v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision ° <br /> Garage n At(— ' <br /> Structure Use: SanitaAt UnX Bc,u w;jn 7 PKln iT 5 <br /> (family ho /cabin, garage,addition, etc.) <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 9 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). 0 0 <br /> 2. Show the location of the well (W),septic tank (ST), and drainflaid (DF). i o m <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building q Z cc <br /> measurement to the ordinary high water mark of lake,stream, or river. C o. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m o <br /> dated by the owner. C <br /> 1 <br /> PLOT PLAN in <br /> _d <br /> ra <br /> SEL ATTACHED a <br /> o I�T <br /> IIS <br /> o � <br /> y <br /> z <br /> n <br /> 1 I_ <br /> n <br /> D <br /> < o 0 0 <br /> 2 <br /> o TN y <br /> O <br /> n � C <br /> g m m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- � o � m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- <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 $ m $ <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. m $ <br /> n V A m <br /> (Dade Reha2m 9/30/92 <br /> SIGN HERE u <br /> (signature of owner or build' onlr (dale) x <br /> ZONING ADMINISTRATOR Q <br /> N NHHT <br /> TOWNSHIP P RMITS MAY BE REQUIRED 9 m <br /> _ 98819888M0 <br />