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Burnett County Office of Zoning Administrator m M0 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 y <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. p 0 <br /> y d <br /> Gec x �� C o <br /> OWNER(Please Pri t) ontractor or Surveyor or Agent <br /> 3�a �7 164 <br /> Address Address <br /> . S 83p <br /> City,Sjate, ip Code y City, State,Zip Code � I <br /> Telephone , Telephone ' <br /> Permit(s)Applied for: <br /> New Building Filling/Grading 4 <br /> Addition Moving o <br /> Sanitary Camping Unit n 0 <br /> 0 <br /> Privy Subdivision 5 <br /> p <br /> ®yr /SIO USS <br /> Structure Use: U v <br /> (family home/cabin, garage,addition,etc.) o a0 <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 7000 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 /> "U..U. �Pyal d0scTipti.i. (13111 the sidu 1131 tilts lurild as 13111 tax stritaiin <br /> 0 <br /> PLOT PLAN 3 <br /> a <br /> Z <br /> IJ � <br /> i <br /> ysa <br /> r <br /> 3; �\ <br /> \✓ 0 <br /> IN <br /> We-LI- C'q,P9�� n <br /> 0 <br /> /I© Z �— <br /> w <br /> z <br /> � I <br /> moo_= <br /> 0 CM0a0aam <br /> m o_ 0 3 <br /> ' y Z o : .2 : 1 <br /> �: m <br /> Cc <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <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 J a : O <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 w <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 /> T <br /> ^` N <br /> SIGN HERE � <br /> (s' atu of ownerorb ld' co actor) (date) o o <br /> ZONING ADMINISTRATOR <br /> N T <br /> V 11 V N O I V <br /> TOWNSHIP PERMITS AY BE REQUIRED N u,�+��8�N m <br /> C g000000N <br /> F <br />