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At County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator y o 0 <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 Bur- m <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 a <br /> tions of the State of Wisconsin. <br /> m O <br /> OWNER(Plea rmt) Contractor or Surveyor or Agent o O <br /> 715 Z2,� <br /> � <br /> Address /1 Address <br /> City, State,Zip de_ City, State,Zip Code <br /> Telephone Telephone J" <br /> 1 <br /> Emergency/Fire No.and Road Name <br /> Legal Description(as indicated on tax statement) o <br /> Permit(s)Applied for: O ( U <br /> 0 <br /> New Building Sanitary Filling/Grading Camping Unit 3 <- <br /> N r <br /> Addition Privy �^ L ,w,ng Subdivision o <br /> Structure Use: �_o / C(� LL//C/� a o <br /> (family home abin, garage type of addition, etc.) <br /> Directions for plot plan drawing: <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NS) and indicate North(N). r <br /> 2.Show the location of the well(W), septic tank(ST), and drainfield(DF). o <br /> 3.Show the location of any lake or flowage- if within 1000 ft. and the location of any river or stream -if within 300 ft. <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 ordi- <br /> nary high water mark of lake, 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. O <br /> 0 <br /> 3 <br /> PLOT PLAN <br /> NZ <br /> N <br /> 0 0 <br /> Ih��\ <br /> a <br /> o' <br /> cc``1 \UA <br /> ' <br /> .L <br /> C/ V <br /> � O <br /> O <br /> 0 <br /> J <br /> O <br /> y � <br /> N Z <br /> a D <br /> 0 Cr 0a= <br /> Z rn 9r <br /> 0 of � [ <br /> N: m <br /> n ' A <br /> o o C <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. o I y <br /> edge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all informs- — Ao m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- o: G <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- <br /> plication.I 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. <br /> m <br /> SIGN HERE 1r4i <br /> (signatur of ownp or building contractor) (date) ? o o <br /> c: 0 <br /> ZONING ADMINISTRATOR <br /> T <br /> N N O N N m <br /> (Po <br /> TOWNSHIP PERMITS MAY BE REQUIRED o000( ppP00No m <br /> 0000000N <br />