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Bumett County Office of Zoning Administrator ; Q f o <br /> APPLICATION FOR — LAND USE — PERMITS = o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m m <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- MM <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- - <br /> tionth%S <br /> State of Wiscon <br /> m m <br /> 02qnyn.A <br /> OWNER(Please Print) Contractor or Surveyor or Agent o. <br /> s+A R��fe '1 5,9 H95 d <br /> Ad ess Address g <br /> /1 / <br /> CV,Stat Zip Code City,State,Zip Code -{-- <br /> Te phone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit r <br /> Privy Subdivision 0 ?� <br /> N <br /> Structure Use: G h o <br /> v <br /> (family home/cabin,garage,addition,etc.) o o <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(OF). <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 0 <br /> P o <br /> Z <br /> 0 <br /> m <br /> C <br /> //�� <br /> 5' r /�G/G <br /> Cr <br /> 1 w <br /> 0 0 <br /> Ila 0 <br /> � N <br /> m n <br /> O O <br /> a99 w <br /> See- v � I(P <br /> See 50` l ?est re �ewo Awl <br /> Z d <br /> 0 <br /> Z <br /> CM-dm0MCM <br /> m a '-'nm an= <br /> o <' p1c00 =3 <br /> Z N ' O p <br /> O � <br /> NCZ�: y <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) <br /> further declare that I(we)recognize that this information I(we)am(are)providing will be relied upon by the County of Bur- i �[ <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- w: <br /> mises at any reasonabl time for the purpose of inspection. ` C° <br /> y E?SIGN HERE �-Q� <br /> (si u of owner or bu' i contractor) (date) o o <br /> e <br /> ZONING ADMINISTRATOR N N O N <br /> OfTN(TO N <br /> TOWNSHIP PERMITS NdYrSE REQUIRED 88888 8 <br />