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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; A o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3. 0 - <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremen s of the ro m !,1 <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the I ws and 3 a <br /> regulations of the State of Wisconsin. y ° <br /> m m <br /> Eugene and Dana Gneen 0 1` <br /> OWRNtER(Please PDXt)147 Contractor or Surveyor or Agent o m <br /> N 8 <br /> Address Address -7 <br /> New Richmond, wI 54017 <br /> City,State,Zip Code City,State,Zip Code <br /> 17151 246-2523 <br /> Telephone Telephone <br /> I � <br /> Emergency/Fire No. and Road Name C <br /> Legal Description (as Indicated on tax statement) Meenon. <br /> Permit(s) Applied for: o ° <br /> Dwelling Addition Filling/Grading Camping Unit °- <br /> v <br /> z o <br /> Accessory Building Sanitary X Privy Subdivision P - <br /> Garage _ 1 <br /> Structure Use: Sanitah UNt �;�� <br /> 0 <br /> (family home/cabin, garage, addition, etc.) <br /> � V , <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) � <br /> l <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate Nort (N). <br /> 2. Show the location of the well (VI), septic tank (ST),and drainfield (DF). 3 m <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c) uiidingZ 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 all;ned and - S <br /> M Xl o <br /> dated by the owner. C C> > <br /> �i,l <br /> PLOT PLAN M <br /> m <br /> 0 <br /> SEE ATTACHED. o } ,� <br /> m <br /> o � <br /> 0 4'� <br /> t <br /> � z <br /> t <br /> f <br /> ro o c m m rDi n <br /> A m <br /> . Do- anN � if <br /> < Z H o 0 <br /> N m <br /> Oro m <br /> :E TNi € s <br /> P m <br /> Ro <br /> m c <br /> 8 ; € M <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of y knowl- 3 : O: m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy Of II informa- a m w O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize thal this infor- 8 0 N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue 3 permit. I ; 8 m 8 <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 O N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 8 m . <br /> m 3 n <br /> A <br /> ro : v H 1 <br /> SIGN HERE (Dade RuAzhotm A nit 13 7192 <br /> (signature of owner or building Contra cto ( te) <br /> C 1 <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MA BE REQUIRED o o O m <br /> 888 vi <br /> i <br />