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Burnett County Office of Zoning Administrator-' 'vi -0 -1 Z <br /> APPLICATION FOR — LAND USE -- PERMITS w 3 <br /> a <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <br /> located as showrlherein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m c S <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 n O' <br /> tions of the State of nWisconsin. <br /> A< H o <br /> Cdr2 #1L1 ff _ g( Go YS /�iN/7+s (� <br /> OWNER(Please Print) Contractor or Surveyor or Agent °' J F <br /> Address Address <br /> City,state,Zip Code _ Y 9 city,stats,Zip Code <br /> Telephone ( Telephone <br /> Permit(s)Applied for: ° <br /> New Building Filling/Grading r <br /> Addition Moving p A <br /> Sanitary Camping Unit c� <br /> 0 <br /> Privy Subdivision - 0 <br /> r <br /> o 0 <br /> Structure Use: � ��/ i✓�' - (ail/ <L/U/<tc, Roo.-- a .9 <br /> (family home/cabin,garage, additi� Z a <br /> P v <br /> Directions for plot plan drawing: a <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. i~ <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. 3 <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. O <br /> rove a ega description on a side o zs orm as on ax statement. 0 <br /> PLOT PLAN 3 <br /> a N <br /> D <br /> Lor ! /N4 <br /> `# sma o ( r <br /> rill 0 <br /> �c ST t `f Gl ti <br /> 0 <br /> �s G4b .n --yf} F (,,. r r l• o �.4j C <br /> 1`i <br /> ° c <br /> —�4 S��L o >; C4 <br /> sCc NY'ryv/.e.l �71 / � t-V <br /> PL.f-i. <br /> i8 I m <br /> Zr m <br /> Z <br /> p 0 <br /> I 364 r <br /> rnv(nr co <br /> a< .a <br /> 9 <: dC0 <br /> o E N: <br /> o c C <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 if 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 an accompanyingschedule and I further declare that I reco nize that <br /> PP C 9 Y ) 9 O, <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a <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 P <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> m <br /> m ,[ <br /> SIGN HERE <br /> re of owner or u' Ing contractor) (d e) <br /> o <br /> ZONING ADMINISTRATOR <br /> GE E <br /> TOWNSHIP PERMITS MAY BE REQUIRED NNoo�o. <br /> 0000000 <br />