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Burnett County, Office of Zoning Administrator ; a £ o <br /> APPLICATION FOR — LAND USE — PERMITS 3_ <br /> s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and - c <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 3 0. <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. m m <br /> N vc <br /> m <br /> OWNER(Please Print) Contractor or Surveyor or Agent a £ <br /> MARVIS H MEL FERGUSON <br /> Address Addr m <br /> HCR59 S27549 SHAKE ROAD MR 59 BOX 478d <br /> City State,Zip Code City,State,Zip Code <br /> S`POONER, WI 54801 SPOONER, WI 54801 00 <br /> Telephone Telephone <br /> Permit(s)Applied for: 715-635-7482 <br /> New Building Filling/Grading <br /> Addition n Moving <br /> /��(y� o <br /> Sanitary C Camping Unit o <br /> Privy Subdivision 0 <br /> N <br /> Structure Use: CABIN ° <br /> (family home/cabin, garage, addition,etc.) Z o <br /> n <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North (N). o <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 /> o �_: <br /> a o <br /> Z M> <br /> 0 <br /> AS ATTACHED <br /> co <br /> n <br /> < Z <br /> w <br /> cn <br /> n <br /> O <br /> w 0 <br /> T <br /> oN' <br /> J M <br /> _ m <br /> V11 Z <br /> O <br /> Z <br /> m c MOW oac <br /> m nom '—'nm nam <br /> wi 2wo °m <br /> y' A <br /> A <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of <br /> my(our)knowledge and belief it is true, correct and complete. I(we)acknowledge that I (we)am(are) responsible for the — E nE i m <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we) jO <br /> further declare that I(we)recognize that this information I(we)am(are)providing will be relied upon by the County of Bur- n: <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the ' ;=i <br /> County of Burnett relying on this information I(we)am(are)providing in this application.I(we)agree to permit county offi- i i b <br /> cials charged with administering county o inances or other authorized person to have access to the above described pre- <br /> mises at any re nable time for the purpt D <br /> se of inspection. 'n <br /> D r: ; <br /> SIGN HERE 8/7/91 o: o <br /> \4signatfirA of owner or uilding contractor) (date) o: o <br /> T� Flanla�n <br /> ZONING ADMINISTRATOR <br /> IJN OIV��N� <br /> to NfTN OOfTm <br /> TOWNSHIP PERMITS MAY BE REQUIRED o000000tmi! <br />