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Burnett County Office of Zoning Administrator d A o 0 <br /> APPLICATION FOR — LAND USE — PERMITS d 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 'Z m <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 /> / N � <br /> � .'a � �q c✓� �� l�� S G�6Hf�. t/yC . a 0 <br /> OWNER(Please Print) Contractor or Surveyor or Agent a 3E <br /> T � <br /> Address �? Address <br /> S��a ti .0n, t'17 1 <br /> City,Stat ,Zl City,State,Zip Code <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading 7p) <br /> Addition Moving o u <br /> Sanitary Camping Unit n G) <br /> 0 <br /> Privy Subdivision 0 <br /> r <br /> a o <br /> Structure Use: d/u Q tr <br /> V <br /> (family home/cabin,garage,addition,etc.) Z o <br /> P a � <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. l?J <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 /> 8. rrovide_Tegal description rsits-- <br /> n <br /> � 3BLOT WLAtJ tax t <br /> Z c <br /> o a <br /> . / LAPP <br /> !V Ipso 0 <br /> / I � <br /> G Joe_OrQ1 <br /> H"Q/did <br /> /lt tw r�posc � �- � • <br /> p 4a•4rlCn <br /> ,C <br /> S 7= �a, U <br /> 0 0 <br /> i,rs' g <br /> 0 <br /> o � <br /> rl 3 £fir Ro4./ 3 A , v D <br /> b <br /> S' 3' <br /> o h � <br /> =a m <br /> «i m <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 <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 <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 v, <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized n <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> ! N <br /> SIGN HERE <br /> (si t re of owner r uilding contractor) (date) v N <br /> o: o <br /> ZONING ADMINISTRATOR $ o <br /> TOWNSHIP PERO ITS MAY BE REQUIRED N Lno.ol N <br /> 00000 g <br />