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ounty Office of Zoning Administrator d 'o o a <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 'Z 5 (� <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m E <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 Wisconsin. (' <br /> o L <br /> -AT 1" knnrng s w <br /> c S? <br /> m � <br /> O NER Please tint) r Contract r qr Surveyor or Agent n <br /> LA)I k�w �"t h r D r <br /> m � <br /> Aqd res Address 1 <br /> iftid�saA) Wt . <br /> City,State,Zip Code City,State,Zip Code <br /> Telephone Telephone <br /> Permit(s)Applied for: X, <br /> New Building Filling/Grading 00 <br /> m <br /> Addition Moving o $ <br /> Sanitary X Camping Unit <br /> Privy Subdivision 0 .`.- <br /> 3 �B ,(n de .n C 13 -i C w c !`e 76,4 f� g <br /> Structure Use: v <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 r <br /> the owner. c" <br /> 0 <br /> 0 <br /> PLOT PLAN - 3 <br /> in A v c <br /> h Z a <br /> o n <br /> IA ?} U <br /> NOCn <br /> 75 , <br /> �5a <br /> Osr <br /> �1 0 / o <br /> w <br /> m <br /> A <br /> X30. 85 �� Z <br /> 0 <br /> Z <br /> I ' <br /> D NVPD <br /> m ate ' m as <br /> N N p <br /> fD <br /> N: m <br /> A <br /> 0 0 c i C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myS: m <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that n i O <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a Cl 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 y <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized ' -P <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> 100 <br /> m <br /> SIGN HERE <br /> (sig ure of owner building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED ���. �. �T <br /> g <br /> 00o 0 <br /> 000 8 <br />