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' / 1I 1 <br /> Burnett County Office of Zoning Administrator m m-- <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 'z m o <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 /> C <br /> 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. - o <br /> m m <br /> c g <br /> OWNER(Please Print)n�1 Contractor or Surveyor or Agent <br /> A ress Address ^ <br /> Lnvy� AZ6,Taal, alAnv- <br /> City,State,Zip Cod / City,State,Zip Code <br /> / :1 <br /> Telephone / Telephone <br /> Permit(s)Applied for: i <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit n O <br /> Privy Subdivision 0 <br /> m r <br /> Structure Use: <br /> (family home cabin, garage,addition,etc.) o v <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 /> the owner. <br /> 6. a description on e si e o is orm as on ax s a emen i? <br /> PLOT PLAN 3 ' <br /> R N <br /> c <br /> Z <br /> a <br /> 0 <br /> � CT <br /> N <br /> \ Z <br /> 7 O <br /> ! Z <br /> / 77 <br /> 5 <br /> I <br /> U <br /> �s <br /> O o< > > na-.m <br /> m a� -'am »nom <br /> cm 0 0 3 <br /> n N O O m <br /> O <br /> U m <br /> no 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 S <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 n <br /> PP (� 9 Y ) 9 G <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 c <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HE <br /> (s' ture of owner or it ' contractor) (date) `^ <br /> ZONING ADMINISTRATOR - C>: <br /> n n <br /> TOWNSHIP PERMITS MAYBE REQUIRED o m <br /> 000 0 0 <br /> 000 0 oVl <br />