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7410 Co. Rd. K, #102 <br /> Burnett County Siren, WI 54872 Office of Zoning Administrator v z <br /> 715-349-2138 APPLICATION FOR — LAND USE — PERMITS 3. P <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and H <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m c <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- <br /> tions n <br /> tions of the State of Wisconsin. 3 3 o <br /> N � <br /> 1397ry P&SLAVSN'y C/ <br /> Pr� ek FNER(PI ase Print) Contra�o orSurveororAgenO04330 GuNNes RD <br /> 00) <br /> A& s �---1- 19C W 15k /D, AddrZ5,0,0C)!✓�r !,-[�� I <br /> City,State,Zip C e -� City,St e,Zip Code K <br /> `77'5 <br /> - 3v— o-33 <br /> `7 9 <br /> Telephone Telephone <br /> Permits)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit $ <br /> Privy Subdivision <br /> Structure Use: <br /> v <br /> (family home/cabin,garage,addition,etc.) o o <br /> a <br /> Directions for plot plan drawing: ,����� <br /> 1. Show the location and size of all existing buildings(EB)and all new I 411di2gs(pl B�ndJpdigate Ndrth(N) <br /> 2. Show the location of the well(W),septic tank(ST),and drainfield(DF ( ��kWvl-� <br /> 3. Show the location of any fake or flowage- if within 1000 ft. and the loco' rant anv wer or strearr_-if within 300 ft. o <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, <br /> river or stream, if applicable. <br /> 5. If,separate plans are submitted by an architect,engineer, builder,contractor,etc.,the plans must be signed and dated by <br /> the owner. 6. Provide legal land description. <br /> n <br /> PLOT PLAN c <br /> 7 / 3 <br /> 1jWCy� 1SLf17vd o n <br /> N <br /> O <br /> t� 1 O <br /> 70f i <br /> IV fit/" <br /> 0 <br /> 0 <br /> N � <br /> O <br /> t L T <br /> Od " IIrV1 <br /> Z <br /> 0 <br /> r Z <br /> r ( � <br /> I� 1 <br /> ° D (n V co rtV7loilkm nom ' y <br /> VIA <br /> 42 <br /> 0 <br /> so M <br /> 2 € <br /> m <br /> 'fir Qo: i 4 <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m c : C <br /> PP (� 9 Y 1 Y ll <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all <br /> information contained in this application(including an accompanyingschedule and I further declare that I recognize that A <br /> PP (� 9 Y 1 9 D <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a o <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized n <br /> person to have a s to the abov pre 'ses at any reasonable time for the purpose of inspection. <br /> T <br /> SIGN HER <br /> (sign a owner or building tr (date) <br /> o: o <br /> ZONING ADMINISTRATOR <br /> N N O N m <br /> TOWNSHIP PEITS RMMAY BE REQUIRED u u u v m <br /> N <br /> �0000 <br /> BIRCH v #3poaj� �UIV/Vo7Sco7T (A-1115-i4r-onl �� <br />