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Burnett County Office of Zoning Administratoro 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> o c <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and '� N <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. m o <br /> Guilio Casci Donald DAniels C O <br /> OWNER(Please Print) Contractor or Surveyor or Agent o <br /> 2210 Bush St, PO Box 316 <br /> Address Address <br /> St- Paul, MN 55119 Sfranr WT 94872 <br /> N <br /> City,State,Zip Code City, State,Zip Code <br /> Telephone Telephone r <br /> i N <br /> Permit(s)Applied for: �� m <br /> n <br /> N• <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary --- Camping Unit o <br /> Privy Subdivision »- <br /> r <br /> O � <br /> Structure Use: v <br /> (family home/cabin, garage, addition,etc.) o <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. 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, 7 <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. <br /> 6. Provide legal description on the side at isform) as on tax s a emen . 03 <br /> PLOT PLAN <br /> a N <br /> c <br /> Z Q <br /> o a <br /> N <br /> O <br /> See Attached <br /> a' <br /> I <br /> n <br /> I <br /> LR <br /> p � <br /> m <br /> O <br /> T <br /> Z <br /> 9 <br /> o <br /> , 1 Z <br /> 1 JJ <br /> Cp <br /> nDD07A <br /> m nti ! <br /> maa� <br /> 9 < N 5's 3 <br /> F' O Jm <br /> � : =f <br /> o " Ni i XI <br /> Z9 m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all = : m <br /> information contained in this application(including an accompanyingschedule and I further declare that I recognize that fi O <br /> PP ( 9 Y ) 9 <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 / ! a <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> n <br /> (sign re of owner or"bu i g contractor) teT— <br /> ZONING ADMINISTRATOR o: o <br /> w n <br /> OWNSHIP PERMITS fill BE REQUIRED o0 000rn <br /> 0 0 000N <br />