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Burnett Cr- ,ty Office of Zoning Administrator d <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 'z ,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. <br /> OWNERjelejsePr' �- <br /> 1q <br /> soy 5A <br /> Contractor Surveyor nt <br /> pt <br /> Addres 1�S l� (ifs //(S V3 Address /n <br /> ,Zip C <br /> City,Stateode City, ate,Zip Code "CV <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building A__ Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit <br /> o <br /> Privy (Subdivision O <br /> Structure Use: <br /> v <br /> (family home/"bin, garage, addition,etc.) o o <br /> v <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. <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. <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and dated by .f. <br /> the owner. (� <br /> o Y <br /> PLOT PLAN B <br /> o <br /> Z <br /> y <br /> _ s�, <br /> U o a <br /> O <br /> Sem ms, µ t LIVK� ,- 5RAj1l/� i'So"J <br /> 0 <br /> a <br /> n <br /> INn <br /> T <br /> J s <br /> GZ <br /> 0 <br /> z <br /> I � <br /> : c'Dw m rDi nc3V <br /> m <br /> c 5' °1cm653 <br /> n O5m <br /> Z <br /> & m <br /> [ c <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all — i : m <br /> PP (including Yaccompanying ) g n <br /> information contained in this applicationan schedule and I further declare that I recognize that <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a o <br /> C; <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing m <br /> in this application. I gree to permit cou ty officials charged with administering county ordinances or other authorized a <br /> person to have acii4t to the above de ribeP; <br /> remises at any reasonable time for the purpose of inspection. <br /> T <br /> SIGN HERE <br /> ( ign e o ner nl ctor) ate) <br /> ZONING ADMINISTRATOR X : <br /> o o <br /> T <br /> TOWNSHIP PERMIT MAY BE REQUIRED ,cn r"n P o'er"o o�m <br /> 000 <br /> 99caA <br />