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Burnett County Office of Zoning Administrator ; m f o <br /> APPLICATION FOR — LAND USE — PERMITS3' ' <br /> z s W <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m 00 <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 3 0. 9 <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- - <br /> tionst e State of Wisconsin. <br /> A <br /> V (�ot�G DoN Pe ('en%S(/L (�cr�nN <br /> OWNER(Pleas Print) C tra t r c urveyor or A ent n £ <br /> 'i3 ED� A�dS 07 ��. fax 3Z'f m <br /> Address Address g <br /> PUCK Vbgl LAKE to 1 S4 B30 <br /> City,State,Zip Code Cit ,State,Zip Code <br /> Telephone Telephone <br /> Permit(s)Applied for. T <br /> New Building Filling/Grading <br /> Addition Moving 0 <br /> Sanitary Camping Unit S <br /> Privy f� Subdivision 6 (� <br /> Structure Use: 3 ""�— o <br /> (family home/cabin, garage, addition,etc.) o 0 <br /> v <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NS)and indicate North(N). .� o <br /> 2. Show the location of the well(W), septic tank(ST),and drainfield(DF). 41 ,. <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 /> 0 <br /> 3 0 <br /> a o <br /> Z <br /> 0 <br /> CD <br /> C <br /> n <br /> N <br /> O <br /> J <br /> N <br /> P <br /> ADpm�N Z <br /> J}l z <br /> 0 <br /> z <br /> F <br /> m c�oyim>nED CEO <br /> c� <br /> n 70 <br /> O J no <br /> J N 37 <br /> 2i m <br /> O i C 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) iO <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- <br /> mises at any reasonable time for the purpose of inspection. <br /> m <br /> SIGN HERE <br /> (si a of cw r building contractor) (date) <br /> ZONING ADMINISTRATOR ` '• ` ` i;9-n <br /> J N O I V N m <br /> TOWNSHIP PE MITS MAY BE REQUIRED 8S8a888w <br />