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Burnett County Office of Zoning Administrator coo f o <br /> APPLICATION FOR - LAND USE - PERMITS - 3. ' <br /> w O <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and v m _n <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 regula- <br /> tions of th State vo <br /> f Wis opsin. - O <br /> —rPc �i'�.�� <br /> OWNER (Please Print) Contr r r uwe y r cir Agent n F <br /> Address Addrm <br /> City,State,Zip Code City,State,Zip Code w <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit <br /> Privy Subdivision o' <br /> �A�A C� <br /> N <br /> Structure Use: E <br /> (family home/cabin, garage, addition, etc.) Z <br /> o <br /> 9 <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. <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 /> Dr� 9 r <br /> ^ r <br /> U ly �),V of <br /> 9u <br /> L u, <br /> VVV — Q <br /> N <br /> O <br /> 7 <br /> O <br /> 7 co <br /> m A <br /> O p <br /> 0 � <br /> �MM <br /> I vv <br /> N <br /> Z <br /> O <br /> Z <br /> 77 <br /> m Nv(�rD Dmf <br /> n Q< > > 0 a— <br /> m arc 'nm ';a� <br /> N � m O Z0 <br /> m <br /> u _ [ C i O <br /> O <br /> Q. i <br /> O 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 j i 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- c <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the :4 <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 ordi5arr5ifs or other aut rized person to have access to the above described pre- <br /> mises at any reasonable time for the purpo ins tion. ` :n <br /> m <br /> SIGN HERE <br /> (signatur of rorbuildirontract ) (date) <br /> ZONING ADMINISTRATOR IU N O N T <br /> v'ut ut o v,m <br /> A <br /> T NSHIP PERMITS MAY BE REQUIRED�1 000 0 ot <br />