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e� 66� ( <br /> Burnett Cavnty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator o a <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 <br /> located as shown 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 n <br /> regulations of the State of Wisconsin. w m <br /> Wendy S Williams Donald Daniels a f <br /> OWNER (Please Print) Contractor or Surveyor or Agent v ', <br /> PO Box 1 PO Box 316 <br /> Address Address <br /> Clear Iakp WT 54005 Siren WT 54877 <br /> City, State,Zip Code City,State,Zip Code a <br /> 71g_aoU„7p81 ��_�no_��33 � � v <br /> Telephone Telephone <br /> none <br /> Emergency/Fire No. and Road Name (, , <br /> IN y' <br /> Legal Description (as Indicated on tax statement) ° N <br /> n 0 <br /> Permits)Applied for: o <br /> Dwelling Addition Filling/Grading Camping Unit <br /> v <br /> z o <br /> Accessory Building Sanitary --X Privy Subdivision o $ <br /> Garage <br /> Structure Use: Mobile home 5 <br /> (family home/cabin, garage,addition, etc.) (yJ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) ?V� <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). o <br /> 2. Show the location of the well (V ),septic tank (ST), and drainfield (DF). v v <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building Z `o <br /> measurement to the ordinary high water mark of lake,stream,or river. o a <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. C I <br /> PLOT PLAN m <br /> , " <br /> See Attached l 0 <br /> .? <br /> 1 s <br /> Cr u, <br /> o <br /> 0. <br /> o � <br /> N IIIwm <br /> I <br /> Z <br /> N <br /> m. Dy.� maN ama <br /> v <M :5 •2H0Mu,' 3 <br /> Z R@ m .z ; 1 <br /> Yq0M TN : D <br /> N 0 <br /> m c C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o 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- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that thisinfor- [ ro N <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 a 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- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have r`c,' <br /> access to the above described premises at any reasonable time for the purpose of inspection. m g <br /> m 3 A m '. <br /> -� , A a 43 1 1 liz; §: <br /> SIGN HERE ( a, <br /> a <br /> (signature of owner or i ntract (date x <br /> ZONING ADMINISTRATOR `. <br /> TOWN PERMITS MAY BE REQUIRED tan ka N o o m <br /> 898 8888ai <br />