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o'j c. kp <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator M 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> d _ o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- <br /> tions of the State of Wisconsin. <br /> — <br /> 6O <br /> cp_4/0 12. .TOHN50N <br /> a 0 <br /> OWNER(Please Print) Contractor or Surveyor or Agent f <br /> 6318 i0 ny <br /> Addressv <br /> Address <br /> OAKDALE MN- 55128 <br /> City,State,Zip Code City,State,Zip Code f <br /> 612-738-6606 <br /> Telephone Telephone <br /> FIRE #28886 WEST YELi-ow klVEP2 AMD <br /> Emergency/Fire No. and Road Name HIST-PAY W/474" S/r401A/6 W AGeES x•4/0 <br /> PGL#90. 16 /SS WOO XIAR;A: 614AS Lor-0 9 AMD / I5d /Nr iN g6rn4r<4*1- *1Z <br /> Legal Description(as indicated on tax statement) C <br /> Permit(s)Applied for: o <br /> New Building Sanitary Filling/Grading Camping Unit y <br /> Addition Privy Moving Subdivision o <br /> Structure Use: syweAC9E SHED z o <br /> 0 0 <br /> (family home/cabin, garage, type of addition, etc.) <br /> Directions for plot plan drawing: <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 drainfield (DF). <br /> 3.Show the location of any lake or flowage-if within 1000 ft.and the location of any river or stream - if within 300 ft. <br /> 4.Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building to ordi- <br /> nary high water mark of 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 dated by <br /> the owner. o <br /> WEST _16L.4-DEd IVEA a4D PRI 3 <br /> PLOT PLAN Z <br /> o n <br /> NORTH y. <br /> s <br /> I <br /> -SJ <br /> 1 <br /> I <br /> our4'K4'E EB m <br /> _ <br /> TI <br /> STORAGE `� <br /> v// <br /> 0'x233' 82' t <br /> WELL LOCATED 2' rRwn NoRrH SIDE OF CAB/At IC, <br /> CA <br /> BIN No 6Eme T<WK Ar rNis lYmE <br /> No OkA/NFIELD Ar TNl6 rime, <br /> 23 <br /> 161' <br /> o c. On On o a_. n <br /> LD. a� -'am =;n3 <br /> u'f � w o �io 3 <br /> P <br /> 0 0: 2 ? <br /> YELLOW 9IV69 52.N <br /> o: <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o = i [ j <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- o` n <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 : a <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 /> m <br /> m <br /> Aot4J. Air � <br /> SIGN HERE <br /> �t re of r or building contractor) ( t /� o o <br /> U v <br /> ZONING ADMINISTRATOR o: o <br /> OCf 1819A0 "N r <br /> TOWNSHIP PERMITS MAY BE REQUIRE f <br /> 0000 of <br /> i 1 <br />