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Burnett County Office of Zoning Administrator o <br /> APPLICATION FOR — LAND USE — PERMITS v = o <br /> z UJ <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m m OQ <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 3 <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. m m <br /> m � <br /> c <br /> m O <br /> OWNER(Please Print) Contractor or Surveyor or Agent ° F <br /> Address Address `D <br /> ST. )2T l., ffd,� 274 1 <br /> City,State,Zip Code City,State,Zip Code � n <br /> TelephoneTelephone <br /> 3)'C/ VVNN''�'VV•((11 J <br /> Permit(s)Applied for: <br /> New Building X Filling/Grading <br /> Addition Moving p <br /> Sanitary Camping Unit <br /> Privy Subdivision <br /> C& Show <br /> a Use: Td /2 i� �F7f ►J <br /> (family homelcabin, garage, addition, etc.) o o <br /> m <br /> the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North(N). .� o <br /> the location of the well (W),septic tank(ST),and drainfield(DF). » <br /> the location of any lake or flowage- if within1000 ft. and the location of any river or stream- if within 300 fl. <br /> dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building to lake, <br /> or stream, if applicable. <br /> arate plans are submitted by an architect,engineer, builder,contractor,etc.,the plans must be signed and dated by <br /> wner. <br /> O <br /> o <br /> 3 <br /> N Z <br /> ° <br /> Z <br /> � r <br /> r7� <br /> a <br /> w <br /> G z <br /> N <br /> o <br /> 7 m8 <br /> 0110a <br /> I T <br /> m <br /> GYFT ° <br /> A Mco MN r DD In-0 <br /> m c _.0 d0o.cm <br /> i f m K' <br /> Z o: Z : 1 <br /> ° 0 : to- S <br /> m <br /> O <br /> o: <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of o i ; E m i <br /> my(our)knowledge and belief it is true,correct and complete. I (we)acknowledge that I (we)am(are) responsible for the ^ i m <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we) i 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- jQF' <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the E kD[ <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- i i i i n <br /> mises at any reasonable time for the purpose of inspection. m <br /> SIGN HERE ✓".."'��_ '^^.ti_ Si"_ ` "' ' w <br /> o: <br /> (Si ure o owner o buil g cc r !tor <br /> ,).�, (date) oo: 80 <br /> ZONING ADMINISTRATOR W' <br /> NNONP. N <br /> P rnrnwo vt <br /> OWNSHIP PERMITS MAY BE EQUIRED 88888 8 <br />