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C'l'1 r�(�n^)t�. <br /> Burnett County Office of Zoning Administrator m v Z <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 /> r y o <br /> ORv� 1VPM)c rhoaLs CvsTorh c�tRN�wT�I o <br /> OWNER(Please Print) Contractor 6rturveyor or Agent <br /> Izzl <br /> OSE W000 Me L- 75941 KW 35 <br /> Address Address `D <br /> ONAtASKR - WI Sy�50 w�t35/�j2 (N1 . 54893 <br /> City, State,Zip d City, State,Zip Code <br /> 1-GO8- 783-`1373 B66- 8181 <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition _ 1 Moving "1y <br /> SanitaryG <br /> Camping Unit <br /> Privy 0 <br /> Subdivision <br /> Structure Use: LL� aC �ea-1 `— <br /> - <br /> c>>' <br /> � <br /> (family home/cabin, garage,addition,etc.) Z o <br /> o <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. 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,contr tor, tc.,the plans must be signed and dated by Y 1 J <br /> the owner. t/ <br /> 6. ro a ega description on a si e o i rm as on ax s a emen o <br /> PLOT PLAN I.,,, o <br /> &AdW ib 6e 32%® ��P 1 1� o a <br /> i PCQ I o <br /> lox $ — <br /> a <br /> cn <br /> �'� I s►moo I ,( d� <br /> V <br /> o l (� <br /> m y <br /> aG � <br /> Z <br /> rn <br /> C )<t yM�� , I rt� <br /> I I � <br /> fnv(nrDD <br /> d � i-QoM kil(sHu�q-rxR I n c<> > 0a .m <br /> m n� am W <br /> � mOo 3 <br /> N. 5�o LAW � �{ 3�Q ° m N <br /> 010N € 2 m <br /> O i : : 01 i 0 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of c C <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 /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that A p <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 <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> ---------------- T <br /> �nf N <br /> SIGN HERE <br /> (signature of owner or uildi g contractor) (d e) ; 8 <br /> ZONING ADMINISTRATOR Is <br /> N N O v T <br /> TOWNSHIP PERMITS MAY BE REQUIRED cnacn<no In <br /> 00000 N <br />