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Burnett County Z410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d 'a -4 c <br /> APPLICATION FOR — LAND USE — PERMITS 3. e <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v H F <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 a Q 00 <br /> regulations of the State of Wisconsin. w a <br /> �I ��f4n1YQ41'l <br /> OWNER(Please Prim) Contractor or Surveyor or Agent o £ <br /> J <br /> K/a �� - <br /> Address Address <br /> W pIs ,m sS �oCo 0\ <br /> City, State, Zip Code City, State,Zip Code I <br /> Telephone Telephone <br /> Emergencylre No.lannd Roa�NVme <br /> �, 9 7 � ' . tvn <br /> Legal Description (as Indicated on tax statement) <br /> ct � <br /> Permit(s) Applied for: o ° <br /> J <br /> m r <br /> Dwelling Addition Filling/Grading Camping Unit o <br /> v <br /> z o <br /> Accessory Building Sanitary Privy Subdivision ° <br /> Garage <br /> Structure Use: o <br /> (family hom /cabi garage, addition, etc.) w <br /> r <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) '0 r <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). C o H <br /> 2. Show the location of the well (yi),septic tank (ST],and drainfleld (DF). 0-411 <br /> 3 <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)buildingp S o <br /> measurement to the ordinary high water mark of lake,stream, or river. o a <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m H <br /> dated by the owner. <br /> PLOT PLAN , e /eU`n-'I I I" /i/efi �>°p�� J�`-"" SCS�dQG� Q}J ' m w Y . <br /> ,N/ air — aln K. <br /> (off � <br /> qS �S Y ( ( N <br /> J <br /> 4- 0 <br /> � akL C24Se , l ��n�l J <br /> R. <br /> f y ill 0 Ll eG1 — in, r�2 � o <br /> E\ o <br /> S <br /> r z <br /> S <br /> f <br /> I 000 <br /> m m o n F ren <br /> Iv <br /> Dai m aH ' <br /> Q N2 <br /> O J m <br /> Z N N 1 <br /> o E Jp T N M <br /> m <br /> g ac C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- : o im m ' 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- » ro N? O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i 'm u, <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 g m 8 <br /> further accept all Iia ility which may be a result of the County of Burnett relying on this information 1 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 abovf described premi es any reasonable timeW the purpose f inspection. r 3 8 g <br /> 3 A <br /> SIGNHERE f' <br /> (signature of owner orb 'Idin <br /> (da <br /> o : <br /> ZONING ADMINISTRATOR <br /> TOWNS P PERMITS MAY BE REQUIRED Yn rn o o m <br /> 8888888a <br /> W i <br /> r� <br />