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Bumett County 7410 Co. Rd- K, No. 102, Siren, Will 54872 Office of Zoning Administrator m ; 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and zz <br /> 9 n <br /> located as stlown 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 <br /> regulations of the State of Isconsin. m <br /> lL2le L. Arron a m <br /> F <br /> OWN lease Pr i Contractor or Surveyor or Agent o <br /> 3 T- ix 14 io�„r 0►-wc <br /> Addres / �� ,r [ r I ( � Address <br /> �J7— N/� h. J J ni , <br /> City,State,Zip Cc a City, State,Zip Code iv <br /> 6 'e3 — <br /> Telephoneo s q G� a n � Telephone <br /> Emergency/Fire No. and Road Narhe �( <br /> Legal Description (as Indicated on tax statement) <br /> Permit(s) Applied for: <br /> N r- <br /> Dwelling Addition Filling/Grading Camping Unit ° <br /> v <br /> z o <br /> Accessory Building Sanitary Privy Subdivision ° <br /> Garage :K � <br /> Structure Use: I a ,'L K rr A 1 -fey S/"Y�`u ✓� o <br /> (family home/cabin,garage,addition,etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 2 <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). 3 m <br /> 3. Showdimenslons infest of thefollowing:(a)buildingtoall lot lines,(b)buildingto center line of road,(c)building � z `o <br /> measurement to the ordinary high water mark of lake,stream,or river. o o. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m N <br /> dated by the owner. C I <br /> PLOT PLAN m -� <br /> 0 Ile <br /> -• I <br /> tj <br /> Z <br /> 1 � <br /> 1 <br /> m o c m m �n 9 <br /> m - ]m0 <br /> c m < - -2 m o 30 m' ; <br /> Z @ o <br /> O Y O T y M <br /> IT <br /> � _ ' O <br /> s : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 0 : m a: m <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa- u it [ O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- n u, <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issa permit. I 8 m g <br /> ue <br /> further accept all liability which may bear ult of the County of Burnett relying on this information I am providing in this ap- <br /> plication.Iagree t it c ty official charged administering county ordinances or other authorized person t°have <br /> N <br /> access to the ve d acri premise t any re naDle time for the purpose of inspection. m S <br /> m <br /> A a <br /> M i u 0 <br /> N a <br /> SIGN HERE <br /> (signaturlit of owner r building contractor) (d e) ? o <br /> p <br /> ZONING ADMINISTRATOR IrUN1 ar a 8 <br /> TOWNSHIP PERMITS MAY BE REOUIRED ( " 8 o o s m <br /> 88888888 ( <br />