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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ,N o / 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> d 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 <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 n <br /> reg at ns of the State/of Wisconsin. <br /> 0 (Pie rent) Contractor or Surveyor or Agent o <br /> Z� /3� <br /> Ars <br /> (/ I Address <br /> City,State, Zip Code City, State,Zip Code <br /> �Telephone _ Telephone <br /> '2/5- 5�- 55' ffC> (1J <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as Indicated on tax statement) <br /> c <br /> Permits)Applied for: o <br /> 0 <br /> J <br /> m � <br /> Dwelling Addition Filling/Grading Camping Unit o R <br /> z o �l <br /> Accessory Building Sanitary Privy Subdivision ° 0 <br /> Garage } <br /> Structure Use: � C<'F >�a� .�I its, <br /> u,0,rit,c, - Q AAit&to 1�6ie 15Aryv ���rf�0�� 1 <br /> amity home/cabin garage, addition, etc. <br /> 1A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1 IN <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfleld (DF). 3 <br /> 3. Show dimensions infeet of thefollowing:(a) bulldingto all lot lines,(b)buildingto center line of road,(c)building z <br /> measurement to the ordinary high water mark of lake,stream, or river. o a <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and () y <br /> dated by the owner. m 0 a <br /> C <br /> PLOT PLAN m jj <br /> b <br /> N <br /> J <br /> N <br /> J <br /> o <br /> N 41tL�/��V1'II <br /> � I <br /> Z <br /> I <br /> 0 O C M. UNd of m <br /> m Da� ?. nN ¢ my <br /> < N' <br /> Z N 0 <br /> fJ TN M <br /> m <br /> G O O <br /> E C <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informa m O <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- <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 u, o <br /> access to the above described premise:,n any reasonable time for the purpose of inspection. m 3 <br /> SIGN HE - — / �2 i N <br /> (sig re of ownecA building contractor) (date) c <br /> i <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED 4N o o m <br /> "88888888 N <br />