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�i L (6, 1 -"-) <br /> Burnett County 7410 Co. Rd. K, #102, Siren, MI 54872 Office of Zoning Administrator in710 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> d o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and rn r� <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- CD 0 1 <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 n <br /> tions of the State of Wisconsin. 'p <br /> W � <br /> .JOW DUR®Illd I?ad PreJ< lQ0,w( a = o <br /> OWNER(Pie e P int) Contractor or Sury yor A ent o <br /> f22 K i 2'17FL� (15 <br /> Address Ad ess <br /> ZIUrt�F/�t1S hJI 5U �r 1 S�j oO <br /> City,State,Zip Code City,State,Zip Code �-1 <br /> Telephone Telephone d <br /> Permit(s)Applied for: I <br /> oG <br /> New Building Filling/Grading .a <br /> Addition Moving o <br /> Sanitary _ Camping Unit n o <br /> Privy Subdivision 0 .`.- <br /> 0 <br /> o �» <br /> Structure Use: <br /> (family home/cabin, garage,addition,etc.) o a <br /> m <br /> Directions for plot plan drawing: (h� <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. (,�� o <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 land description. O <br /> 0 <br /> PLOT PLAN 3 ti <br /> 0 a <br /> v <br /> O o <br /> I � <br /> G > a <br /> o <br /> C a' <br /> O <br /> a <br /> 0 <br /> N <br /> 0 ;t <br /> 7 <br /> m J <br /> _O <br /> N t � <br /> T r <br /> r TJ <br /> c <br /> c O:r0 aacc.m <br /> MDa 0 m anm <br /> - <br /> N O 0 1p <br /> Z <br /> M <br /> 0 : D <br /> o c <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o 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 further declare that I recognize that > ; p <br /> PP C 9 Y ) 9 <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 a <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> N <br /> SIGN HERE <br /> (s na ur of owne o building contractor) (date) v: N <br /> o: o <br /> ZONING ADMINISTRATOR 2 <br /> o: o <br /> T <br /> TOWNSHIP PERMITS MAY BE REQUIRED N��. oo�m <br /> oo�oob <br /> 00 000fp <br />