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Burnett County Office of Zoning Administrator W __ <br /> APPLICATION FOR — LAND USE — PERMITS = 3. <br /> 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 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 of the State of Wisconsin. <br /> o v h <br /> OWNER(Please Print) ContraZr or Surveyor or Agent o j rn <br /> AddressD <br /> Address <br /> City, State,Zip Code City, State,Zip Code N <br /> N <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit o 0 <br /> 0 <br /> Privy Subdivision 0 <br /> '" r <br /> Structure Use: <br /> v <br /> (family home/cabin, garage, addition, etc.) o a <br /> m <br /> Directions for plot plan drawing: <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 drainfield(DF). <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. C' S�� <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. S <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. l_x) <br /> n <br /> PLOT PLAN N 3 Yr, <br /> co <br /> I f36 6� l� Z 4 Q <br /> _ ) 0 <br /> o <br /> tu <br /> r <br /> I rt <br /> �+ NB 05T �� = <br /> F7BtGE nQ 0 V1 <br /> T <br /> D�w i5' 13 a, 8s ' <br /> 0 <br /> C�.urF� Ziac: f <br /> 0 a w o o act\ , <br /> N'I \�Jy O o'�O/ <br /> Z o: m� I _ <br /> O o ] <br /> ^: <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m <br /> PP ( 9 Y ) 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 any accompanying schedule and I further declare that I recognize that ` A E <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a r' 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 ` a <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> ~ T <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> i o; : o <br /> ZONING ADMINISTRATOR /.i i•; '! ;'I ;l / j/) i : o E i o0 <br /> / )/j •.'Gi i '•i i i vat <br /> ,TOWNSHIP PERMITS MAY BE REQUIRED ��;p,�'oo,�r <br /> 00 ;o 0 0�0 r <br /> 0 o(o;0000C <br />