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eumett County Office of Zoning Adminis rator o o <br /> APPLICATION FOR — LAND USE — PERMITS13 <br /> z <br /> d = <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work describ d and v w <br /> located as shown herein.The undersigned agrees that all work shall be done In accordance with the requirements of tl a Bur- 0 n <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and egula- — <br /> tlorp of the State of Wisconsin. » <br /> �nloP1-TdUUk/S � C w <br /> OWNER(Please Print) Contractor or Surveyor or Agent O <br /> Address J <br /> Address <br /> l <br /> CNState,Zip Code City,State,Zip Code 1� <br /> Telephone Telephone <br /> Permit(s)Applied for. <br /> New Building Filling/Grading <br /> Addition Moving /J <br /> Sanitary V <br /> Camping Unit m C7 <br /> Privy » <br /> Subdivision o <br /> = L� <br /> w <br /> Structure use: To r 0 <br /> (family hometcabin,garage,addition,etc.) z 'o <br /> a <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NB)and Indicate North(N). c <br /> 2. Show the location of the well(W), septic tank(ST),and dralnfleld(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 r <br /> 4. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,within hin 3 300 0ding t ft. 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 dal ad by <br /> the owner. <br /> lip <br /> a <br /> 1314 fi, o <br /> N <br /> m <br /> c <br /> v a <br /> a <br /> � o <br /> J <br /> E3 I G <br /> i � <br /> ro <br /> 0 0 <br /> G J <br /> Q 7 J <br /> N <br /> Z <br /> o <br /> Hyl z <br /> V A <br /> M dl v(nr DD Wy <br /> w cmwwOnc <br /> 0 v 3JOo.-.m <br /> w n� ,.:nw <br /> Z O =m <br /> 0 <br /> O <br /> M 2 : m <br /> I(we)declare that this application(Including any accompanying schedule)has been examined by me(us)and to the best c f <br /> my(our)knowledge and belief it Is true,correct and complete. I(we)acknowledge that I(we)am(are)responsible for th <br /> detail and accuracy of all Information contained In this application (Including any accompanying schedule) and I (w ) ' : ! p <br /> further declare that I(we)recognize that this Information I(we)am(are)providing will be relied upon by the County of Bu - i 4-, <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of th a iof f <br /> County of Burnett relying on this Information I(we)am(are)providing in this application.I(we)agree to permit county off- <br /> cials charged with administering county ordinances or other authorized person to have access to the above described pr - ' a <br /> mises at any reasonable time for the purpose of inspection. m <br /> SIGN HERE � ' <br /> ?TOWNSHIP <br /> e of owner building contractor) (date)ZONING ADMINISTRATOR (�PERMITS MA E REQUIRED $$$$$ <br />