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Burnett Coynty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator cn ' 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. 0 <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and y <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m J <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. o <br /> io m <br /> N � <br /> o � hen a o <br /> OWNTR (Plea Pint) Contractor or Surveyor or Agent o m <br /> Addres u C1C - Address m <br /> City, State, Zip Code City,State,Zip Code <br /> Telephone Telephone <br /> Emergencyff ire No. aqqd F�oad Name <br /> L gal Description (as indicated on tax statement) <br /> n M <br /> 0 <br /> Permit(s)Applied for: 0 'K- <br /> m r <br /> Dwelling Addition Filling/Grading Camping Unit ° g <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision o } <br /> Garage / J) G �� <br /> Structure Use: �� o <br /> (family home/cabin, rage, additio etc.) l/T <br /> DIRECTIONS FOR PLOT PLAN DRAWING: 21 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). 0 <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (D17. <br /> 3. Show the location of any lake or flowage-If within 1000 ft. and the location of any river or stream-If within P <br /> 71 z 0 <br /> 300 ft. 0 n <br /> 4. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building m o <br /> to lake, river or stream, if applicable. DO 0 <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and Cy 1 <br /> dated by the owner. M ,� Z <br /> PLOT PLAN I <br /> U <br /> I N <br /> o <br /> 70 <br /> �O <br /> m <br /> o � <br /> I z <br /> D <br /> a m < m C mO o mo 3 <br /> G y Z N <br /> P F 0 : TZ <br /> < Cr m <br /> i cis ' ID <br /> 8 iate : <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- c <br /> € m m <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs- w m ur O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- a 8 0 N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $ m $ <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 u o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m $ m <br /> m i 3 Aill <br /> n . <br /> m m yp <br /> H b O <br /> SIGN HERE <br /> (signal of owner or building contractor) <br /> Z N D NI TRA O <br /> TOWNSHIP PERMITS MAY BE RE UIRED m <br /> 88 888 (Mn <br />