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Burnett County Office of Zoning Administratord 0 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 6 <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- <br /> tions of the State of Wisconsin. = o <br /> N m <br /> Lyn o <br /> OWNER(PI se P ' t) Contractor or/Surveyor orpo ent O <br /> Al(lulu I k- �i(�C'_ k J (r'l;t C _ IAC`: <br /> Ad r ss \ Address _ <br /> City,ST Code City,State,Zip Code 1 <br /> vC' <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit n o <br /> Privy Subdivision ^`.- <br /> r <br /> a o <br /> Structure Use: M <br /> (family hometcabin,garage,addition,etc.) o <br /> m <br /> Directions for plot plan drawing: 7 <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 /> p O <br /> LOT�UAde legal description (on the side of this form) as on tax statement. 0 <br /> 'R 0 <br /> c <br /> Z D <br /> O a <br /> N <br /> Ui <br /> pc. <br /> �i <br /> 01 <br /> 0 <br /> 0 <br /> O JJ <br /> m <br /> O <br /> m � <br /> n <br /> ?i <br /> m J, <br /> Z <br /> O <br /> 1 Z <br /> JJ <br /> m a� =am =am <br /> N_ 2NO =f0 <br /> O O z <br /> ' C' <br /> u€ [ m <br /> v n : Q <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 0 : A <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 /> PP (including Yaccompanying ) g _ n <br /> information contained in this application includin an schedule and I further declare that I recognize thatC—) <br /> a : O <br /> i <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue ao : <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 � a <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> D <br /> SIGN HERE <br /> (suture of owner or building contractor) (dale) <br /> ZONING ADMINISTRATOR <br /> 'TOWNSHIP PERMITS BE REQUIRED c N m <br /> 0000000N <br />