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Burnett County Office of Zoning Administrator N v -1 <br /> N F C <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> d o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 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 a <br /> tions of the State of Wisconsin. V, <br /> �K4, �/ E � I IOe �S - JcevcQ��PvG �an`� V' <br /> OT�R Iarse Pri� Conuactor Surveyor or Agent o �, <br /> even LA <br /> Address Addresso S <br /> (. � Y Y_9 � <br /> City,State,Zip CodeCity, State,Zip<o dg <br /> Telephone Telephone _ <br /> Permits)Applied for: 0� <br /> New Building Filling/Grading —Z <br /> Addition Moving R <br /> Sanitary Camping Unit o <br /> Privy Subdivision m »' <br /> at✓In -tl 0 r Yl � a <br /> Structure Use: � <br /> (family homel abin,garage, addition, etc.) Z <br /> o � <br /> m <br /> } <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). 7 <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, <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 /> de legal description (on the side of this farm) as on tax statement. 3 <br /> LO � t'! a N <br /> c <br /> Z <br /> o a a <br /> m. <br /> o � <br /> � G <br /> k, : <br /> tr, rn <br /> C ll` 0 <br /> N <br /> J <br /> O <br /> a <br /> 0 <br /> N � <br /> O <br /> ti T <br /> N <br /> Z <br /> O <br /> I Z <br /> N D <br /> m c 7)U)iunacM <br /> Rl <br /> m nc _.nm nom <br /> N [ WHo �a� 3 <br /> m <br /> 2 O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myXl <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all A i i m <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that <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 acceqAto the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> fD <br /> SIGN HERE <br /> (si lure of own r building contractor) (date) <br /> o: o <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMIT MAY BE REQUIRED `JaN N o N o 0 <br /> 0000001 <br />