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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; 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 w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the Se of Wisconsin. w m <br /> OWNER Please int) Contractor or Surveyor or Agent o <br /> '33,75 kwe51 P <br /> Address � `/ Address <br /> l wAj till S7T7 <br /> City, State,Zip Code City, State,Zip Code <br /> 1 <br /> Telephone / y �y Telephone <br /> Emergency/Fire No. Road Name <br /> a d �$ <br /> /n (/o <br /> Legal Description (as indicated on t s tement) <br /> 0 <br /> Permit(s) Applied for: 0 <br /> H r 4 <br /> Dwelling Addition Filling/Grading Camping Unit g <br /> v <br /> Z o <br /> Accessory Building 4—, Sanitary Privy Subdivision P <br /> Garage L <br /> Structure Use: C//i o- Lyg4' t.- <br /> If <br /> (family home/cabin, garage,addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) M <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). O o <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). o o m <br /> 3. Show dimensions in feet of the I ollowing:(a)building to all lot lines,(b)building to center line of road,(c)building Z c <br /> measurement to the ordinary high water mark of lake,stream, or river. a <br /> 4. If separate plans are submitted by an ar -hl ee[huLlder.contractor t be signed and m �: <br /> dated by the owner. - p --- - - --- -- - --- — - - - C <br /> PLOT PLAN UTP TF tka � f M ql� A <br /> N 0 t1 <br /> h 3-1�14a 6 <br /> W <br /> 5 ` N <br /> N n <br /> C> G o <br /> 0 <br /> r� o <br /> n 3p° W <br /> 36D t I- °e <br /> I ri �, Z <br /> r <br /> p <br /> aD� m o c � m � � Da F th <br /> O 10 3 <br /> N \ <br /> m <br /> '1 u a <br /> m A .. C <br /> 8 = i i <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowI J 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 informs- w` :m N O <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- ,`b'm <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 m 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 n <br /> access to the abo described premises at any reasonable time for the purpose of inspection. m 8 <br /> m 3 A N <br /> m <br /> 8 <br /> SIGN MFR / J <br /> ( ' net owner or ui ing t[�ctor) (d te) o Y <br /> �., 8 <br /> ZONING ADMINISTRATOR g ' <br /> TOWNSHIP PERMITS MAY BE REQUIRED �n u 1 X'';8 8 8 m <br /> 8888'888m <br />