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Burnett County Office of Zoning Administrator 0 0 <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 � y <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m <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. p <br /> �gufQ �ERRonJ <br /> a <br /> OWNER(Please rent Contractor or Surveyor or Agent o <br /> 595 0 �1. Ar:llond /Jye i <br /> Addr ss Address <br /> wl,r c bear"xt /Y)!l. 55'60 7� <br /> City,State,Zip Code City,State,Zip Code <br /> ( 6)Z} 429 - 3ZZ 3 <br /> Telephone s TelephoneV1— <br /> Permit(s)Applied for: <br /> New Building Filling/Grading (nl� <br /> Addition Moving o -� <br /> Sanitary Camping Unit o <br /> Privy Subdivision w <br /> E; 0 <br /> Structure Use: Q b rnv v <br /> (family home/cabin, garage,addition,etc.) 0 0 <br /> 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. <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 <br /> theowner. 6. PROVIDE LEGAL DESCRIPTION AS SHOWN ON YOUR TAX STATEMENT. O <br /> PLOT PLAN _ - _._ �.. c w <br /> o a�6 < II <br /> 5 1Vrn1`I <br /> v!P <br /> _. F `� Z <br /> 1 Z <br /> O <br /> 0 <br /> _ o <br /> O <br /> in y <br /> i <br /> n <br /> T <br /> < Z <br /> O <br /> Jyyoco <br /> l� 7p <br /> .. O O [ <br /> Vol' 5 p g m <br /> Lot l� G. s. m. , Pc,5e '77,97, �,o�af�d ��, the SE /►E � 24 -41 -i5 (Srr o � € o <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 <br /> € <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that Aa : p <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a o <br /> 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 N <br /> in this application. I agree to permit co ty officials charged with administering county ordinances or other authorized ` <br /> person to have cess to the above d c bed premises at any reasonable time for the purpose of inspection. <br /> T <br /> SIGN HERE `• Z0 — 39 <br /> (signature cKrowpler or buildin tractor) (date) Q o ; o <br /> o: o <br /> ZONING ADMINISTRATOR o o <br /> WNSHIP PERMITS MAY BE REQUIRED ((V�}yNP�� �� m <br /> 0000 o m <br />