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co z <br /> Burnett County Office of Zoning Administrator 0 f <br /> APPLICATION FOR — LAND USE — PERMITS z o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and - <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula33 <br /> - <br /> tions of the State of Wisconsin. (1 <br /> TRACY DURAND C 0 0 <br /> OWNER JlPlease Print)_ Contractor or Su` °' <br /> 1598 CHRISTNER ROAD PIS' :ECAVATION m_ <br /> Address Address , BOX 4 d <br /> SPOONER, WI 54.801 Spooner. WI sMI -� <br /> City,State,Zip Code City,State,Zip Code (715)835,7482 roh <br /> I <br /> Telephone Telephone <br /> Permit(s)Applied for: 1 <br /> New Building Filling/Grading '— <br /> Addition Moving o <br /> Sanitary X Camping Unit <br /> Privy Subdivision 0 <br /> w <br /> Structure Use: 2 BR HOME o <br /> (family home/cabin, garage, addition,etc.) z o <br /> P v <br /> m <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. �� 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,contractor,etc.,the plans must be signed and dated by D <br /> the owner. <br /> 0 <br /> O <br /> 3 0 <br /> 9 O <br /> CT Y R C��}s�� +b (24,L 9—i 5+vn e✓ Cffr S T-) 1ST" , <br /> co <br /> 1 �ou5e dk I e� � _ Pffn <br /> _ Cn C <br /> 01 <br /> c <br /> I a <br /> w <br /> O <br /> J <br /> 1 <br /> AS ATTACHED <br /> m <br /> 2 0 <br /> N J <br /> .On <br /> l N <br /> Z <br /> O <br /> Z <br /> 9 <br /> m c�wm rDi nc�� <br /> m a C r;a� <br /> N Z N O J m <br /> P J ' <br /> en E : M <br /> 2I„ : mCi <br /> : : D <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of 30 <br /> my(our) knowledge and belief it is true, correct and complete. I (we)acknowledge that I (we)am(are) responsible for the i m <br /> detail and accuracyof all information contained in this application (including an accompanyingschedule and I we <br /> PP (� 9 Y ) ( ) <br /> further declare that I(we)recognize that this information I(we)am(are)providing will be relied upon by the County of Bur- :r <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the ': <br /> County of Burnett relying on this information I(we)am(are)providing in this application.I(we)agree to permit county offi- <br /> cials charged with administering county ordinances or other authorized person to have access to the above described pre- a <br /> miles at any reasonable time fort urpose of inspection. ET i <br /> SIGN HERE �"2.� <br /> ( ig ature of ner or building contractor) <br /> o: o <br /> ZONING ADMINISTRATOR ti / N-n <br /> cn oornm <br /> 0o Doom <br /> TOWNSHIP PERMITS MAY BE REQUIRED o fA <br /> CJ <br />