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Burnett 'County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator iv - o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> m o <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 m ; N <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the <br /> �State <br /> o�f/Wisconsin. n r N d <br /> OWNER (-i2 Print) y Jf Contractor or Surveyor or Agent o m <br /> Address Address <br /> tiByDy Ui r S ti � <br /> 01 State,Zip Cody, T City, State,Zip Code 1 r <br /> Telephone Telephone "7 <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as indicated on tax statement) <br /> n L7 <br /> Permit(s) Applied for: 0 <br /> m � <br /> Dwelling . Addition Filling/Grading Camping Unit 0 o <br /> Z vo <br /> Accessory Building Sanitary Privy Subdivision ° 3 <br /> Garage <br /> J <br /> A <br /> Structure Use: - ��' 0 <br /> (family home/cabin, garage,addition, etc.) Milt <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 <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). �3 v, <br /> 3. Show dimensions infest ofthefollowing:(a) building to all lot lines,(b)building to center line of road,(c)building MZ `c <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 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 O J <br /> PLOT PLAN I QS �� f�crC c �O ©�7��I m , <br /> Cnnc1 ,(' S of P �YYIi ,l <br /> G� �e !'i(/af� �Ke- l�S el(4c�� `7� 144ee <br /> re- I <br /> r�o�� r � �thal , C,ifq res c) <br /> C (a se r y <br /> O <br /> Sem ��4 ILS <br /> Z <br /> R <br /> &jejrY- Z�1P + <br /> o c m w a 7 m <br /> Q J J O p 0 m <br /> D < : `2 N O 7 J i <br /> L-1 m <br /> o f J31 <br /> _ T: m <br /> N : �2i O <br /> 8 9 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my nowl 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 int rma. N O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- m vI <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 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- w <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized parson to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> m A x <br /> SIGN HERE <br /> (signature of owner r ildi once ! -.e)_ <br /> Z 8 ' <br /> ZONING ADMINISTRATOR ` <br /> TOWN IP PERMITS MAYBE REQUIRED <br /> -- -- 8 8 <br />