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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ( o a <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 0 <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 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regu tions of the State of Isconsin. <br /> i marl Eoe�cn /l��rK Krause_ a f <br /> OWNER (P gent <br /> ryo <br /> Addr s Addr s <br /> nokI br10 , moJ �y lire <br /> City, State, Zip Coaw City, ate,Zip Gp e, l <br /> Telephone Telephone Lf C� <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as Indicated on tax statement) <br /> 2 c <br /> Permit(s)Applied for: �- <br /> r^ r <br /> Dwelling Addition Filling/Grading Camping Unit S <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision ° } <br /> Garage <br /> Structure Use: r <br /> 0 <br /> (family home/cabin, garage, addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: G <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). M 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 01 <br /> o c <br /> 300 ft. o a <br /> 4. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building m <br /> to lake, river or stream, if applicable. <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and Cy <br /> dated by the owner. <br /> m <br /> PLOT PLAN <br /> I <br /> chemo eSn'L U) <br /> 90 <br /> 13 <br /> m 0 <br /> o <br /> w <br /> to <br /> I D <br /> m. Da'� �nm a10 xt <br /> v < U1 ' Z m o On m 3 <br /> Z @'o <br /> m <br /> C <br /> � <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- S [ A [ ; 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- ,» y,�, .ni 0 <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 <br /> 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- N <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have 1 0, <br /> access to the above described premises at any reasonable time for the purpose of inspection. ' 0 8 <br /> H in 8 <br /> SIGN HEREn <br /> (signature of owner or building contractor) (date) <br /> o : x: <br /> ZONING ADMINISTRATOR <br /> H. <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o-9 m <br /> 88888888th <br />