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BurnettCountyCounty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> T V Z <br /> £ <br /> APPLICATION FOR — LAND USE — PERMITS d 3 . <br /> z ° <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 3 c <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and _ o <br /> regulations of the State of Wisconsin. m <br /> OUP, LAbV of Pc2PErU4L Aap n f <br /> OWNER (Please Print) Contractor or Surveyor or Agent <br /> SAI 5T- <br /> Address Address <br /> 1")RaIA0Q1 I VZI� 54 '30 ) <br /> City,State,f'iZip C7 <br /> 'de 3,, City,State,Zip Code ) Vt <br /> Telephone Telephone J(1 <br /> Emergency/Fire No. and Road Name �. <br /> Legal Description (as Indicated on tax statement) f.) �t(' 9 A M �/2D01�S i S T- AD n. r O /yrjA40I)AY <br /> 5 F`�y A) W 5 E C fid' TSI N RI(oW%ocUNarFSWi55 0 0 �1 <br /> Permit(s) Applied for: <br /> o <br /> Dwelling Addition Filling/Grading Camping Unit v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision i <br /> Garage ` fC <br /> Structure Use: <br /> (family home/cabin,garage, addition,etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). O o <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 3 <br /> 3. Show dimensions in feet of the I ollowing;(a)building to all lot lines,(b)building to center line of road,(c)building � Z c� <br /> measurement to the ordinary high water mark of lake,stream,or river. ° n <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 /> I <br /> PLOT PLAN III -E�j <br /> Se e_ II <br /> C m <br /> G <br /> el <br /> a 5�� o <br /> FOo <br /> Z <br /> I� <br /> A <br /> oz YN m o n F rail <br /> } "— M <br /> N <br /> N O J m 3 <br /> e � <br /> M <br /> m <br /> 8A i 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 /> hat I am responsible for the detail and accuracy of all informs- d.m <br /> edge and belief it is true,correct and complete.I acknowledge t <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- g m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <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 00 <br /> k: ' 8 <br /> access to the above described premises at any reasonable time for the purpose of inspection. m > N <br /> N i � <br /> SIGN HERE (date) <br /> (si at a of owner or I ing contra tor) 9 : x <br /> ZONING ADMINISTRATOR a <br /> TOWNSHIP PERMITS MAY BE REOUIRED <br /> 7 n n o 0 <br /> e <br /> 888 $ 888m <br /> a <br /> 0 <br />