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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U) m .o <br /> APPLICATION FOR — LAND USE — PERMITS d <br /> O c <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 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. <br /> 0 aPlease Prim t)c. V f c c-p$ Contractor or Surveyor or Agent o <br /> £ <br /> Q6x dGa c- <br /> Addre�-ss Address <br /> � �k l-c/I �5�gS3 <br /> City, Code City,State,Zip Code <br /> 3-3 <br /> Telephone Telephone Telephone <br /> Emergency/Fire No. and Road Name? <br /> Legal Description (as Indicated on tax statement) <br /> L <br /> Permit(s)Applied for: 0 <br /> Dwelling Addition Filling/Grading Camping Unit °^ C' <br /> v <br /> Z o I <br /> Accessory Building Sanitary Privy Subdivision ° m <br /> Garage J �) <br /> Structure Use: C�1��)��I�J 5 <br /> ( miy home/cabin, garage, addition, etc.) I <br /> 1A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) M J <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 draiMield (DF). 11 3 v, <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)buildingz `c <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 y <br /> dated by the owner. 0 <br /> p C I <br /> PLOT PLAN <br /> 6? C <br /> r� <br /> y <br /> ^l'I `�) n <br /> 0 <br /> zhlZ 0i <br /> m <br /> GO&O - we- <br /> ro" Z <br /> -4 Plt;); Vy <br /> o . � dd �a � <br /> m m <br /> zcmc000 �a _ C <br /> mm <br /> o MO <br /> m <br /> c � m <br /> 8 : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- S M <br /> 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- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 m g <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- a <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have n o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m a 8 <br /> p , a <br /> m <br /> A <br /> SIGN MERE <br /> (signatur f owner or building contractor) (date) <br /> o : x <br /> ZONING ADMINISTRATOR <br /> H_ <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 88888888rmn <br />