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Burnett County 7410 Co. Rd. K, #102, Siren, NI 54872 Office of Zoning Administrator m M0 a <br /> APPLICATION FOR - LAND USE - PERMITS3_ <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 c <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 n <br /> tion <br /> ^^off the State of Wiss�c�o(nsin.�/y�-� <br /> 0 ESR(Plea Print) Contractor or Surveyor or Agent o <br /> Ad res L 93 Address <br /> City,State,Zi Code —7 City, State,Zip Code <br /> .-)/`iL' ! �� <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> 1 <br /> New Building Filling/Grading <br /> Addition Moving v <br /> Sanitary Camping Unit o 0 <br /> Privy Subdivision 0 <br /> 7 0 <br /> Structure Use: <br /> (family home/cabin, garage,addition,etc.) o 0 <br /> m <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 within300 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 lake, <br /> 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. 6. Provide legal land description. O <br /> 0 <br /> PLOT PLAN <br /> 9 :A <br /> Z a <br /> O n <br /> 0 <br /> L� pc �►� t PPRD AL a 0173 � <br /> i e <br /> n <br /> 0 <br /> J <br /> N <br /> J <br /> J <br /> O <br /> m ,y <br /> O <br /> m <br /> (D <br /> Z <br /> LTJ � Z <br /> m c m n nmv <br /> 0 c, J 0n-'m <br /> N O J n <br /> Tn€ - m <br /> A, O <br /> o! c c <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all m <br /> information contained in this application(including an accompanyingschedule and I further declare that I reco nize that O <br /> PP C 9 Y ) 9 ; aE <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a o <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am Providing n <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized <br /> person to have access to the above described pr mises at any reasonable time for the purpose of inspection. <br /> T <br /> A <br /> SIGN HERE <br /> f owner b. � in contractor) (date) <br /> o: o <br /> ZONING ADMINISTRATOR aru� p <br /> ( OWP�P'P o �mNSHIP PERMITS M BE REQUIRED om <br /> oc>00000tp <br />