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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator0 0 <br /> APPLICATION FOR - LAND USE - PERMITS3 0 f <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 2 c o `1 t <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 0. <br /> regulations of the State of 'sc nsin <br /> (b E <br /> OWNERr4�n Pry /�_6 Contractor or Surveyor or Agent o <br /> Address ((.. Address <br /> City, State.QQde �- City, State, Zip Code <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as indicated on tax statement) <br /> 0 <br /> Permit(s) Applied for: o <br /> of � <br /> Dwelling Addition Filling/Grading Camping Unit o <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision 0 } <br /> Garage &g1� l- <br /> Structure Use: rl6fi � <br /> (family home/cabin, garage, ad(ition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: 2 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). 0 <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). C 3 <br /> 3. Show the location of any lake or flowage- if within 1000 ft. and the location of any river or stream - if within <br /> 300 ft. o n <br /> 4. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road, (c)building H <br /> to lake, river or stream, if applicable. M o <br /> 0 <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C0 <br /> dated by the owner. M <br /> PLOT PLAN <br /> I a <br /> 0 <br /> 0 <br /> I� <br /> o <br /> 0 I(_' <br /> O � <br /> 70 <br /> N_ <br /> n <br /> ( 2 <br /> Z <br /> A0 � U) v D a O V <br /> D o c . m f m <br /> u o <br /> < � m o o ,o <br /> o F 0 m ,� <br /> 0 �! <br /> In <br /> NS � C O <br /> 8 : 2 c C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. o m j a <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- Fn m d+ O <br /> lion 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. 1 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- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> SIGN HERE <br /> (si t e of o building contractor) (date) <br /> ZONING ADMINISTRATO 8 <br /> p N N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED LIT <br /> m u u v u . o o m <br /> 88 $ 8 888m <br />