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0n C9 f �► <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrel0 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and Z m <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m m <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 (1 y <br /> tions of the State of Wisconsin. <br /> M 1p r N p <br /> m�-�i� `��\ t • \D� `v� w <br /> OWNER(Pie rant) Contractor or Survey r or Agent �- F <br /> A r s Address `" <br /> City,State,Zip Code City,State Zip Code <br /> �144��Q�=7� 930(0- `rte[ $ <br /> Telephone Telephone <br /> Emergency/Fire No.and Road Name <br /> Legal Description(as indicated on tax statement) o <br /> Permit(s)Applied f r. o <br /> New Building Sanitary Filling/Grading Camping Unit 6 .<.- <br /> w � <br /> Addition Privy Moving Subdivision g o <br /> R <br /> \ckal o <br /> Structure Use: X Za P � <br /> (family homelicftffi,garage,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). o <br /> 2. Show the location of the well(W) septic tank(ST),and drainfleld(DF). <br /> 3. Show the location of any lake or flowage-If within 10D0 ft. and the location of any river or stream -if within 300 ft. '11 <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, C <br /> river or stream, if applicable. X <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and dated by C <br /> the owner. v W <br /> PLOT PLAN Off Z v <br /> 0 0 <br /> M <br /> 3I <br /> (A G <br /> m <br /> —D <br /> lu <br /> o <br /> ql .s <br /> w <br /> 2 <br /> 70 <br /> f <br /> W rA-0mr D DWV <br /> m c �.w w 0ncm <br /> a < dCm iS�ic <br /> mi Z � O �m <br /> Z O <br /> TN: <br /> M <br /> 811 <br /> declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- o; rn <br /> tion contained in this application(including any accompanying schedule)and i further declare that 1 recognize that this infor- Ei %A g i O <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <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- i $a S <br /> plication.1 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. i O c): <br /> Ti N <br /> m cNx: <br /> SIGN HERE 1" 8i <br /> (si nature of owner or ng contractor) (date) c <br /> ZONING ADMINISTRATOR E <br /> TOWNSHIP PERMITS MAY BE REQUIRED .. 8M <br />