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Burnet County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator o a <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of theSlateof Wisconsin. / C' w m°O_ <br /> LL.C",� G>�vC J- .X=".i'r!_/✓VC' �C%it�S� n m O <br /> OWNER (Please Print) Contractor or Surveyor or Agent o <br /> �� <br /> Address Address <br /> City, State, Zi Code State,Zi Code <br /> P P <br /> '(/x t� � 3 <br /> Telephone -2 5-5�- Telephone <br /> Either <br /> .�C Arm r j L�ONM L�KG1 4` <br /> Enter cy/Fire No. and Road Name V <br /> L .1nif atedonlarzslatentent) o <br /> n 0 <br /> Permit(s) Applied for: o ° <br /> ° <br /> w r <br /> Dwelling Addition � Filling/Grading Camping Unit S ° <br /> v <br /> z o <br /> Accessory Building Sanitary Privy Subdivision P � <br /> Garage <br /> Structure Use: /We <br /> (family home/cabin, garage, addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) M <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). o <br /> 2. Show the location of the well (W),septic tank (ST), and grainfield (DF). an 3 N <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building 11Z c <br /> measurement to the ordinary high water mark of lake,stream,or river. o n <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m N <br /> dated by the owner. C ) <br /> PLOT PLAN [A <br /> SU <br /> I <br /> qU S���r II <br /> o` <br /> o <br /> iL o N <br /> �dl r;X 3 L <br /> r z <br /> a <br /> F )V C'" <br /> o c m m o a F m <br /> atDM <br /> .. S 0 < ; vi 07 � 3 <br /> Z Ao ' A,z : 01 <br /> �.___ ,_--_. P F T m <br /> N <br /> /t_—/ 8 ii �_ : o <br /> ` ry C C <br /> It <br /> 1 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 informa- a m w O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ,rNn <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I S 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 premise t any reasonable time for the purpose of inspection. w 8 m <br /> r 3 n <br /> � « <br /> A b A <br /> SIGN HERE <br /> (si re of o n or qding contractor) ,\ �—._-: ( ale) o x' <br /> S� <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> N N O N88 M T <br /> ( N N N N o o b" m <br /> `ul APR pNN 2 81992 8888ssssy <br />