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Burnett Cgunty Office of Zoning Administratorw o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3_ <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and N <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- 3 a y 111 <br /> tions of the State of Wisconsin. <br /> Steve Klug 3 m o <br /> OWNER(Please Print) Contractor or Surveyor or Agent o N J <br /> 3844 17th Av. S. X <br /> m (D <br /> Address Address c <br /> Minneapolis. Mn. 55407 <br /> m <br /> City,State,Zip Code City, State,Zip Code ) m <br /> (612) 722-0400 <br /> Telephone Telephone <br /> Permit(s)Applied for: 09 <br /> New Building Filling/Grading <br /> Addition Moving R <br /> Sanitary X Camping Unit o <br /> Privy Subdivision m »' <br /> r <br /> o � <br /> Structure Use: ro <br /> (family home/cabin,garage, addition, etc.) Z0 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 /> 0 <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 o <br /> the owner. <br /> n <br /> ov a ega escription on the side this form) as on tax tement. o <br /> PLOLAI� <br /> N <br /> c <br /> ♦ Z Q <br /> 7 <br /> I <br /> � ro <br /> SEE TTACHED `D <br /> w <br /> m <br /> J/ <br /> Peon o <br /> N N <br /> C.L� A <br /> O <br /> J <br /> N N <br /> O W <br /> J <br /> O <br /> .. W <br /> \� A <br /> jV Z <br /> O <br /> Z <br /> r. <br /> p <br /> m N 01 D DOo'o <br /> ate » Mm am <br /> v F W553 <br /> N O J <br /> O F. <br /> 1 <br /> Ni i S <br /> M <br /> )o: E <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 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 any accompanying schedule)and I further declare that I recognize that > O <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a 0 <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 1 <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> (sign ete of owner or buil g contractor)p (date) <br /> -RATOR <br /> T <br /> ,l <br /> irOWNSHIP PERMITS MAY BE REQUIRED �N ooNm <br /> 0 a000(n <br /> j <br />