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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m _0 o <br /> APPLICATION FOR - LAND USE - PERMITS 3. <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 ^ Co <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. w m <br /> J. E. Hennich <br /> a o <br /> f <br /> OWNER ((Please Print) Contractor or Surveyor or Agent m <br /> 176 Campbe22 StA eet <br /> Address Address <br /> Pnescott, WI 54021 <br /> City, State, Zip Code City,State,Zip Code e <br /> (715) 262-3317 (� <br /> Telephone Telephone <br /> EmergqenIyFire No. and Road Name <br /> peK. SW 1/4 SE 1/4 Sec. 20 T40N R15E. Town of Jackson S� <br /> Legal Description (as Indicated on tax statement) ° ') <br /> o <br /> Permit(s) Applied for: 0 �. <br /> '^ r <br /> Dwelling Addition Filling/Grading Camping Unit ° <br /> v <br /> z o <br /> Accessory Building Sanitary X Privy Subdivision ° <br /> Garage < <br /> Structure Use: SanitaAy OntU a <br /> (family home/cabin, garage,addition, etc.) Mill <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 9 <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 (Nr),septic tank (ST), and dralnfield (DF). o o m <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 <br /> measurement to the ordinary high water mark of lake,stream,or river. ° n <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m a <br /> dated by the owner. C <br /> PLOT PLAN m , n <br /> Y' <br /> d (� <br /> A <br /> O <br /> 0 <br /> SEE ATTACHED. ° I� <br /> p <br /> o � <br /> N <br /> 0 <br /> I D <br /> C 1 <br /> A O C =. a 0 n c. g Im <br /> 9 <br /> 60 y W M <br /> < = dao 10 .o 3 <br /> f 0 T� M <br /> c ^ <br /> N [ G) O <br /> $ nc C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o A `� i m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of alt informs- pp!! m O <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this infor- 75 n a <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I [ g m $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O 0 <br /> access to the above described premises at any reasonable time for the purpose of inspection. m $ A <br /> n V A u <br /> SIGN HERE Wade Ru6zhotm 4118192 <br /> a [ <br /> (signature of owner or building contr c or) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> 8$ 8 $ 8888 ,0 <br />