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Barnett county 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratorm o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d o <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 m m v <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. H m <br /> q <br /> OWNER (Please Prim) Contractor or Surveyor or Agent ) <br /> Address Address _ <br /> DiVI <br /> City,State City,State,Zip Code <br /> Telephone Telephone l,'b <br /> U ' <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as Indicated on tax statement) <br /> c o <br /> Permit(s)Applied for: 0 <br /> m � <br /> Dwelling Addition Filling/Grading Camping Unit 6 g <br /> v <br /> Z o <br /> Accessory Building SanitaryPrivy Subdivision ° m <br /> Garage 74— <br /> /7`/�f/n <br /> Structure Use: " ' '/'(,," 6 <br /> (family home/cabin, arage, addition, etc.) 'C-- g <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) M <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 drainflaid (DF). 3 <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building I Z o <br /> measurement to the ordinary high water mark of lake,stream,or river. o n <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. --- C C� 0 <br /> PLOT PLAN <br /> S <br /> JJ oV , <br /> I m <br /> n <br /> o <br /> J <br /> N <br /> O Ilf/yJ <br /> J <br /> J <br /> O � <br /> N <br /> Z <br /> I S <br /> e <br /> mu» rmm > c � <br /> D = C -0 0. <br /> o <br /> Q In <br /> C <br /> m X!1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- c m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- O <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 ! 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. m $R [ <br /> m 3 yA r <br /> SIGN HERE '� H� a <br /> (signature o w r o it c! rector) I ate) c Fr <br /> ZONING ADMINISTRATOR / g ' <br /> T NSHIP PERMITS MAY BE REQUIRED $, ,0 o 8 m <br /> 889rmn <br />