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Burnett County Office of Zoning Administrator 00 '00 £ o <br /> APPLICATION FOR — LAND USE — PERMITS z 32-1 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m H <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 0 C <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- - <br /> tippTof the tate of yJisco sin, /] /�� �� m <br /> ll �� � hzx s� l�l�rch - tu'is• Oo4. M- 0� 1I L{5k�<� e O <br /> OWNER(PleaPG�rriint) Contractor or Surveyor or Agent n £ <br /> �� o J <br /> m � <br /> AAdressAddress = - <br /> City,State,Zip Cod City,State,Zip Code <br /> Telephone x I J Tel phone <br /> Permit(s)Applied for. <br /> New Building Filling/Grading s <br /> Addition Moving o <br /> Sanitary Camping Unit <br /> Privy Subdivision o <br /> JA�1 'ca lo <br /> Structure Use: v <br /> (falmily homelcabin,garage,addition,etc.) Z o <br /> P a <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, -n <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 /> 0 <br /> v o� <br /> Z <br /> �rowl n( 6 `n <br /> I a <br /> N <br /> V <br /> J N <br /> J R <br /> (p A <br /> v c <br /> N J <br /> .Ar <br /> q1) <br /> m <br /> Z <br /> 0 <br /> z <br /> 0 m >nCD'a <br /> w: o J c <br /> Z <br /> o: <br /> o J : <br /> m <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) ' 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. I (we) further accept all liability which may be a result of the a <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- E n <br /> mises at any reasonable time for the purpose of inspection. ' E <br /> r � <br /> n: <br /> SIGN HERE - <br /> (at at re of owner building cp ntractor ( ate) i o: E b <br /> 0 <br /> ZONING ADMINISTRATOR <� N o N m <br /> m <br /> J OWNSHIP PERMITS AY BE REQUIRED o 0 000lmi) <br />