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0�) (& <br /> Burnett County Office of Zoning Administrator ; E o <br /> APPLICATION FOR - LAND USE - PERMITS 1 <br /> 3. <br /> 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 Co <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. w m <br /> N <br /> C <br /> . o. fOWNER ri Contractor or Surve or or A entPP ATERSON MOON <br /> d <br /> Address Address <br /> 1150 WEST POINT RD. HCR59 HCR59 BOX4.78d _ <br /> City,State Zip Code City,State,Zip Code <br /> SPOONER, WI 54.801 SPOONER, WI 54801 <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving oIK <br /> Sanitary XXXX Camping Unit <br /> Privy Subdivision o' <br /> Structure Use: <br /> h�iy 1 C 1h� 0 <br /> (family home/cabin, garage, addition, etc.) z <br /> 1 0 0 <br /> v <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 /> 1 <br /> 2. Show the location of the well(W) septic tank(ST),and drainfield(DF). v <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. o <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. UN <br /> 0 <br /> 0 <br /> o O <br /> Z <br /> � M <br /> AS ATTACHED <br /> LAI <br /> �L rn <br /> Ul c <br /> Q <br /> n <br /> N <br /> O <br /> CC <br /> O <br /> w_ <br /> n Z' U <br /> T <br /> m O <br /> Z <br /> N o <br /> Z <br /> Y <br /> f <br /> M 0)-U(Ar DD coy <br /> 0 Q <br /> a n <br /> � .:nm ,:n� <br /> Zw0 �m3 <br /> Z O: : m' : 1 <br /> 5 : <br /> =i S <br /> ^w m <br /> Cc <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 /> O 9 ( 1 (are) 9 P Y y <br /> Bur- <br /> further declare that I we recognize that this information I we am are providing will be relied upon b the Count of Bur- <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 coq9ty ordinances or other authorized person to have access to the above described pre- E i i <br /> La <br /> mises at any asonable time for tt#purpose of inspection. L51= U <br /> �'�"�----------- -.� <br /> ia' E E <br /> !i <br /> SIGN HERE 6 <br /> (?tnialbre of caner or buildin ntrac (da�E11.t 1991 E o E 8 <br /> JWl7�fYY <br /> ZONING ADMINISTRATOR o N�I <br /> U U1v oo nm <br /> TOWNSHIP PERM TS MAY BE REQUIRED Soormn <br />