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Burnett County Office of Zoning Administrator ; 3 o <br /> APPLICATION FOR — LAND USE — PERMITS 4 = 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- 3 a <br /> nett County Land Use Ordinance,Sanitation Code,and with all other plicable County Ordinances and the laws and regula- - <br /> tion of the ate of Wi 5onsin. �� w m <br /> r �„ _+ P)f)S ray 6c� c� <br /> 0 <br /> OW(�5' (P ea P� t) r �h P�/�I Contractor or Surveyor or Agent o � <br /> Isor` d m <br /> Ad ress Address `D <br /> anIawoA m r� <br /> Cit yy Stat ,Zip Code �./ City,State,Zip Code <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving O <br /> Sanitary Camping Unit <br /> Privy Subdivision 0 <br /> Structure Use: <br /> I (family hometcabin,garage,addition,etc.) 0 0 <br /> v <br /> m <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North(N). .c 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 /> O <br /> 3 <br /> v o <br /> Z <br /> 0 <br /> a <br /> Qj <br /> 5 <br /> N <br /> o I(yTl/\{\111 <br /> O N <br /> m <br /> (p ° <br /> O 0 <br /> w � <br /> � r� � <br /> Z <br /> Z <br /> ° <br /> Z <br /> M <br /> y' WWfD <br /> p �rO"T` <br /> ` to iS <br /> o c m <br /> bo 0 : <br /> I o: '• ' c i ` C <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 m <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we) I O <br /> further declare that I(we)recognize that this information I(we)am(are)providing will be relied upon by the County of Bur- <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the : PE <br /> County of Burnett relying on this information I(we)am(are)providing in this application.I(we)agree to permit county offi- ` zD' <br /> cials charged with administering county ordinances or other authorized person to have access to the above described pre- i i Sn <br /> mises at any reasonable tim r the purpose of i ect!on. - ' ` .n i <br /> i7Tri <br /> nn (9 <br /> SIGN HERE <br /> is, ure of owner o uildingn contractor) (date) �(Jy�f�� : . E o <br /> ZONING ADMINISTRATOR <br /> �,� NUt UtNO N <br /> M <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />