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Burnett County Office of Zoning Administrator ; m f o <br /> APPLICATION FOR — LAND USE — PERMITS 3 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- 3 n <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 Wiscons' .. <br /> �F��/S �C11��oeo MAml SArm9 <br /> m <br /> OWNEPrint) Contractor or Surveyor or Agent o. F <br /> ie T__ / Bax33c w <br /> Address Address <br /> WseB kAKF I W/5 <br /> City,State,Zip Code City,State,Zip Code <br /> 7iS--2 <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving <br /> 0 <br /> Sanitary Camping Unit <br /> Privy Subdivision o <br /> Structure use: L78/3 I S%O!Z�) SNED ° <br /> (family home/cabin, garage, addition, etc.) Z <br /> 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(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 /> a <br /> Sof p <br /> C <br /> w <br /> o <br /> 00 u, <br /> CO <br /> m <br /> Z <br /> / o <br /> z <br /> 7 r4 <br /> Qq� <br /> r � <br /> 0c w m � a c <br /> o v<» on–.m <br /> _ Z u, o =ro — <br /> o: <br /> Cis P <br /> v : n : 0 <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of o <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) Ep? f 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- . : <br /> nett Wisconsin in determining whether to issue a permit. t (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 ' spection. - '• ;nE <br /> SIGN HERE <br /> (sig tur of owner or buiAng,-e6ntractor) (date) E o i S <br /> ZONING ADMINISTRATOR <br /> NON N <br /> TOWNSHIP PERMITS MAY BE REQUIRED 000800g <br />