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Burnett County Office of Zoning Administrator Cn m -0 o <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 y <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 n r) <br /> tions of the State of Wisconsin. v <br /> U w m <br /> r J 1A.I _l � a <br /> OWNERPleas Prin <br /> I o <br /> ) Contr ctor or Surve or or A ent f <br /> 'm <br /> Addre n Addy s i <br /> City,State,Zip Code City, State,Zip Code \ <br /> Telephone Telephone n <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit 0 G1 <br /> 0 <br /> Privy Subdivision <br /> o � <br /> Structure Use: v <br /> (family home/cabin, garage, addition,etc.) o <br /> m <br /> Directions for plot plan drawing: .7L <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 /> 6. Preivide legal descriptiu., (un the side or tiiis rurm) as on tax atntement. O <br /> 0 <br /> PLOT PLAN 3 <br /> a y <br /> Z Q <br /> o n <br /> N <br /> I o <br /> J <br /> ^� 0 <br /> r C .V <br /> ® � N <br /> 0 <br /> 0 9� <br /> 0 <br /> T <br /> N <br /> Z <br /> 0 <br /> Z <br /> 77 <br /> m c jpNi iu>> <br /> 9 G O C w 0 0 <br /> w Z y p �,p <br /> c rn <br /> Q <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 m <br /> ; <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that 1 Ac ; p <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 'O <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 /> (signature of owner or building contractor (date) <br /> ZONING ADMINISTRATOR <br /> »'n <br /> TOWNSHIP PERMITS AY BE REQUIRED pppu000m <br /> 0000000 <br /> 0000000 Cn <br />