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County Office of Zoning Administrator) m -- 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d o <br /> TO ,. ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and � y r <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 /> 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. = o <br /> N m <br /> Gerald A. Guldin D. B. C. Const. a = O <br /> OWNER(Please Print) Contractor or Surveyor or Agent o <br /> Pt 1 - Rnx 478 x4510#® 23040 Shuttleworth Rd. � oQ <br /> Address Address <br /> Siren. Wisc. 54872 Siren, Wisc. 54872 Sv <br /> City,State,Zip Code Cit Sts e,Zi Code <br /> (715) 349-2998 (��15� 689-2591 <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building X Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit n o <br /> Privy Subdivision 0 <br /> r J <br /> Garage <br /> Structure Use: v <br /> (family home/cabin,garage,addition, etc.) o v <br /> m <br /> Directions for plot plan drawing: r <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. O <br /> PLOT�0A,4 a legalescrip on on the slull Wrthi on tax stateme t. 3 <br /> �m <br /> Z Q <br /> o a <br /> 1 - <br /> o I <br /> �i <br /> wetly ! Q o 8 ti <br /> _ <br /> � o � <br /> N ! EK �D <br /> m ,TBT <br /> � 13 <br /> FT 1p,•9�. o <br /> K I <br /> o <br /> SHED iI1 \ 1 V <br /> \o � <br /> LU <br /> mGI �vnacm� <br /> 0 a m a� =am ^n.M <br /> <. 91 CN o-3 <br /> O ; 1 <br /> n (� <br /> c <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 a p <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 m <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized a <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> ! A <br /> SIGN HERE 8-21-89 �^ ' <br /> (si at re of owner building contractor) (date) 93 `^ <br /> V P <br /> O: O <br /> ZONING ADMINISTRATOR �� o <br /> TOWNSHIP PkfMITS MAY BE REQUIRED N N O N <br /> (T(n N(POIT <br /> 0 0 0 0 0 O <br />