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Burnett County Office of Zoning Administrator m 7 o o <br /> APPLICATION FOR - LAND USE - PERMI S3 r <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and N t <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m m _t <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 a <br /> tions of the State of Wiscon o <br /> 57 <br /> c 7- a o <br /> OW EER.(Please Priq '� Contractor or Surveyor or Agent <br /> n,t()1_ o <br /> A rens Address \ <br /> JSYoo <br /> City,State,Zipr Code City, State,Zip Code n' F <br /> Qi 5' - 3 <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit o <br /> Privy Subdivision 3 N <br /> Structure Use: 7ie .✓ <br /> (family home/cabin, garage,addition, etc.) o <br /> o <br /> m <br /> Directions for plot plan drawing: � z <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North(N). i <br /> 2. Show the location of the well (W), septic tank(ST), and drainfield (DF). L r <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. �� o (� <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, j; <br /> river or stream, if applicable. U) <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 /> 60L f4LA a legaldescription on a side a is form as on tax statement. 0ltj (on <br /> Zc' <br /> 0, y <br /> i <br /> v C) <br /> ty <br /> o �V <br /> K-{% '. <br /> S <br /> C m <br /> n <br /> <-� t, o <br /> 8-7 <br /> �. Z <br /> 31 to V cnr DDW'fl <br /> c _.own acm <br /> o a< o o a-' <br /> m <br /> rn ? 0o5,n <br /> z o: <br /> ° i [ C' i M <br /> m <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 any accompanying schedule)and I further declare that I recognize that a tJ <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a — oo <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing a <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized <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 /> 0 y/6 5� �y <br /> ` <br /> (sign r of ner or ing contractor) (date) ' o[ o <br /> n: <br /> ZONING ADMINISTRATOR <br /> o: o <br /> NN ooNm <br /> TOWNSHIP PERMI S MAY BE REQUIRED o 0 0 0 0�fn <br /> 000000` N <br /> I <br />