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.unett County Office of Zoning Administrator m � 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> iv o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m <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. p <br /> 'o <br /> OW Pleasat) //// Contractor or Surveyor or Agent o. <br /> �Tn c�7• � ^ � <br /> Addr Address <br /> City,State, Code City,State,Zip Code <br /> �2?j 357—3 <br /> Telephone Telephone <br /> Permit(s)Applied for: I <br /> New Building Filling/Grading I''C' 7D <br /> Addition Moving o j <br /> Sanitary Camping Unit o '"(\ <br /> Privy Subdivision 0 <br /> / m r <br /> Structure Use: v <br /> (family h me/cabin, garAge,addition,etc.) o a° <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 /> rove a legaldescription on a side o is orm as on ax s a emen O <br /> o <br /> PLOT PLAN 3 <br /> a rn <br /> Z c <br /> o a <br /> N <br /> O <br /> nX./ <br /> 9j <br /> JAY <br /> G <br /> , J <br /> O0 Itlll`1J\�Iy\\ <br /> J <br /> Z I^ <br /> N N` <br /> Z <br /> Z <br /> I <br /> 00aGm <br /> n o•aJ no.—m <br /> 9 = ' vOJ3 <br /> Z Ny 0 J m <br /> O : '2 : <br /> 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 o <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 m <br /> PP (including Y P Y 9 ) g <br /> information contained in this application includin an accom an in schedule and I further declare that I reco nize that <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a o <br /> 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 n <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE ii7 <br /> (si ture wner or )iwino contractor) (date) <br /> ZONING ADMINISTRATOR ` <br /> TOWNSHIP PERMITS MA"E REQUIRED N N O J N m <br /> FFFnnn v v'v,o o v m <br /> � �000000M <br />