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Burnett County Office of Zoning Administrator m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS d 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 67 <br /> m <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m m <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 n - <br /> tions of the State of Wisconsin. <br /> J 0 HfJ s TRUNL-Eiz �f� Sflvn� <br /> OWNER(Please Print) Contractor or Surveyor or Agent <br /> Address Address <br /> DA03uP.'V( �CAtf S C- S eo Sid <br /> City,State,Zip Code City,State,Zip Code <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving O <br /> Sanitary Camping Unit 0_ O _ <br /> 0 <br /> Privy Subdivision - o Z <br /> Structure Use: F'q/f) V Hem 1 - � 0►�� -l.- <br /> (family <br /> (family home/cabin,garage, addition, etc.) o c° <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. r- <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 /> the owner. <br /> O <br /> 6PI-Cf,RKVAWE LEGAL DESCRIPTION (on the side of this form) as on TAX STATEMENT. 3 <br /> N ti�w LAKE z <br /> 0 <br /> f / <br /> ..r- 3o' �-li ao' STo2 !o r CA to <br /> I-mo o PW�UNS <br /> 014 <br /> y 0) <br /> v <br /> o <br /> uG 7 \ <br /> I �� t IL 6467 M Fvmf- <br /> \ Na>6E <br /> V Def J���� -7j Z <br /> II o <br /> i ( <br /> - DGARA; o a C mm a, ' nm a a y�1 'o <' m c y o 5C <br /> t. P Z N ur o M <br /> N <br /> O O 1:2 <br /> D ' rn: M <br /> I dec are that this application (including an accompanyingschedule has been examined b me and to the best of m o c C <br /> PP ( 9 Y 1 Y Y p: m ? y <br /> knowledge and belief it 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 recognize that wv' <br /> PP ( 9 Y ) 9 ` C <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 <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized .0 <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> T <br /> SIGN HERE <br /> (sign re owner or b c ntractor) (date) E E N <br /> o: o <br /> ZONING ADMINISTRATOR <br /> n <br /> TOWNSHIP PERMITS AY BE REQUIRED N��� mCn <br /> 000o <br /> 0 0 0 oOm <br />