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Burnett County Office of Zoning Administrator m £ o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> z 0 <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 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 /> m _? <br /> OWNER(Please Print) Contractor or Sup�ft�C n F <br /> Gene Korduplesxi � LAVATION <br /> Address Address RCR 59, BOX fD <br /> 1964 DEER TRAIL RD .SpOM, WI 54R[N <br /> City,State,Zip Code City,State,Zip Code (715)M7482 <br /> SPOONER, WI 54801 <br /> Telephone •-I/S- ( cnaL Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary XXXXX Camping Unit <br /> 15 <br /> Privy Subdivision 0 <br /> m <br /> Structure Use: 3 BEDROOM HOME <br /> v <br /> (family homelcabin, garage, addition,etc.) 0 0 <br /> a <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. 3n <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, b_ <br /> river or stream, if applicable. .06 <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and dated by O <br /> the owner. <br /> A rs <br /> 0 <br /> a <br /> AS ATTACHED Z n <br /> 0 <br /> m c <br /> n <br /> p G <br /> SIJ <br /> N <br /> O ^ <br /> N <br /> o � o <br /> T <br /> m a� �'nmaa� <br /> v p1 -mo="3 <br /> N_ `Z - '0 ]I° <br /> Z ° : : PQ 1 <br /> O = : co <br /> wi c m <br /> o: <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of ` E m i ; A <br /> my(our) knowledge and belief it is true,correct and complete. I (we)acknowledge that I (we)am(are)responsible for the E E m <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we) iA 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- p <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 cpqnty ordinances or other authorized person to have access to the above described pre- <br /> mises at any easonable time for Tyl purpose of inspection. <br /> SIGN HERE 9/01./92. <br /> s nature of q&ner or building con ra o at <br /> ZONING ADMINISTRATOR _ ` d'T <br /> TOWNSHIP PERMIT MAY BE REQUIRED o0 000tmi) <br />