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04) ebmpl <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m c ZO <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 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. w <br /> Robert Rutledge Donald Daniels a £ <br /> 024785P1Owl Lake Rd cornractotoXsurYeyor or Agent o � <br /> Address Address <br /> fS 31b a <br /> Webster WI 54893 Siren WI 54872 <br /> City, State,Zip Code City, State,Zip Code <br /> 715-349-7640 715-349-5533 <br /> Telephone Telephone <br /> [Fr, N dci�� <br /> E74� tgyff17 Leke 12 oaclName pct in GL 3 S6 T38N R15W <br /> Legal <br /> /Description (as Indicated on tax statement) <br /> n 0 <br /> O <br /> Permit(s)Applied for: 0 It. <br /> r <br /> Dwelling Addition --k— Filling/Grading Camping Unit ° o <br /> v <br /> z o <br /> Accessory Building Sanitary X Privy Subdivision <br /> Garage <br /> V <br /> Structure Use: "' t ' � I 1 <br /> f mily home/cabin, garage, addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) M \N <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 (W),septic tank (ST),and drainfield (DF). 3 <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building I Z v <br /> measurement to the ordinary high water mark of lake,stream,or river. a <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and O y <br /> dated by the owner. C � 0 <br /> PLOT PLAN w <br /> M <br /> See attached State plan <br /> a <br /> I <br /> N <br /> m <br /> n <br /> a O <br /> IfJ <br /> O Ili <br /> J I\, <br /> J <br /> O � <br /> f/1 <br /> Z <br /> IUl <br /> A o c m m a m <br /> = a <br /> a <br /> o F 0 T� <br /> cc In <br /> L" O <br /> n c [ C <br /> 8 ' AA : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o M m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. 8 m <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 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 ; m 8 <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> A : 9 A <br /> ���'IVL - 9/24/93 <br /> SIGN HERE <br /> (signature of ow er r but d' <br /> ZONING ADMINISTRATOR <br /> TOW SHIP PERMITS MAY BE REOUIRED f"n N 0 0 9 m <br /> 88 $ 8880 <br />