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Burnett County Office of Zoning Administrator0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <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 c <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. <br /> /f�if ✓ �� b0ber- Dern <br /> o <br /> OWNE (Pte se/ Print) , Contractor or Surveyor or <br /> 7 A ent o. <br /> �. I � - <br /> / aC . � � n <br /> Address Address -� <br /> inbun�; 1,c% ,5�/�� �� Oun Iia I le44. ML] 55r 1(�3 <br /> City,Stat— e, i City,State,Zip Code - <br /> (-*77�50) Rte- <br /> Telephone Telephone <br /> Permit(s)Applied for. <br /> New Building Filling/Grading (� <br /> Addition Moving o <br /> Sanitary Camping Unit n cf <br /> o Q <br /> Privy Subdivision Q <br /> Structure Use: �/ / ��u /!G M <br /> (family home/cabin, garage, ddition,etc.) o 'o <br /> D <br /> N <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,contrac e p at be signed and dated by <br /> the owner. <br /> Flovide ega escrip .ion on a sr e o is orm .as on ax s emen o <br /> PLOT PLAN 3 <br /> a N <br /> `Ec <br /> Z a <br /> XPi <br /> 0 <br /> I J <br /> -r- <br /> s9j < < W <br /> I y <br /> 00J <br /> J <br /> 0 <br /> y <br /> n <br /> T <br /> / O <br /> 2 <br /> i a <br /> n <br /> X <br /> cZ.mmo ac� m <br /> n Q< J o 0 -.m <br /> o. <br /> m arc - nm »nS <br /> w O J <br /> N � y O no <br /> Z <br /> 0 : : `2 <br /> O J : <br /> m <br /> o: <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 <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that a m� m <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a 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 <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 /> LOU <br /> m <br /> SIGN HERE O of <br /> (signr ur of owner or buil ,eontractory (date) <br /> O O <br /> ZONING ADMINISTRATOR f -f✓s! ✓ o. o <br /> /TOWNSHIP PERMITS M Y BE REQUIRED rn Inov�m cn m <br /> 00000g4l <br />