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Burnett County Office of Zoning Administrator w0 0 <br /> APPLICATION FOR — LAND USE — PERMITS ' <br /> d o <br /> N <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 n <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. ie m A n <br /> JOHN MENTH A.M.EARTH'MKS CONST. INC U) <br /> OWNER(Please Print) Contractor or Surveyor or Agent n <br /> 4915 RUSSELL AVE S . P.O.BOX 71 d <br /> Address Address `D <br /> MINNEAPOLIS . 10 55410 SPOONER, :vi 54801 <br /> City,State,Zip Code City,State,Zip Code <br /> 715-635 7595 <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving p <br /> Sanitary X Camping Unit <br /> Privy Subdivision o <br /> N <br /> O <br /> Structure Use: v <br /> (family home/cabin, garage, addition, etc.) o 0 <br /> 0 <br /> A <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. N <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 /> 0 <br /> O <br /> 3 <br /> v o <br /> SEE ATTACHED SHEET z <br /> 0 <br /> coa <br /> a <br /> e <br /> N <br /> O I <br /> O N <br /> m <br /> �O O <br /> O O <br /> O <br /> C <br /> ( m <br /> C/ O <br /> /r Z <br /> O <br /> 2 <br /> I <br /> n m <br /> m a am ^;nom <br /> o < 91 Q' <br /> 0 c <br /> Z rn Zm _ <br /> p': m� <br /> ei € m <br /> 8 '• 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 m : ': 9 <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) 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 <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- jNo <br /> mises at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> (si ure of owner or ilding contractor) (date) [ o o <br /> ZONING ADMINISTRATOR N o N mmA <br /> v , cn oov <br /> TOWNSHIP PERMITS MA4 BE REQUIRED o 0 000f <br />