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Burnett County Office of Zoning Administrator m o <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> z <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and v 0 1- <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 Wisconsin. <br /> Robert Merker Donald Daniels m <br /> m <br /> OWNER(Please Print) Contractor or Surveyor or Agent o. F <br /> 516 2nd Ave. E. PO Box 316 m <br /> Address Address <br /> Durand, WI 54736 Siren, WI 54872 <br /> City,State,Zip Code City,State,Zip Code 0V, <br /> 715-6177-8o15 715_349-5588 I 'mss <br /> Telephone Telephone cr <br /> Permit(s)Applied for: m <br /> New Building Filling/Grading <br /> Addition Moving <br /> v <br /> Sanitary X Camping Unit <br /> Privy Subdivision o <br /> SRNI 0 <br /> Structure Use: - ON�u <br /> (family homelcabin, garage,addition, etc.) Z <br /> P ° <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 /> 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, r t 1 <br /> river or stream, if applicable. v� <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. Ej <br /> 0 <br /> 0 <br /> 3 <br /> a O <br /> X P i R z <br /> a, <br /> SEE ATTACHED <br /> u, <br /> S Al • a <br /> Q 0 <br /> rq <br /> O <br /> � N <br /> � m <br /> m0 <br /> ^rY^/ O 0 <br /> Zm <br /> Z <br /> O <br /> Z <br /> 9 <br /> 9 aiv�DDWy <br /> m arc m ';a� <br /> � o ° <br /> 12� i U!i i � <br /> ` s m <br /> n ; E O <br /> OE c C <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of l(�C�j1 <br /> my(our) knowledge and belief it is true, correct and complete. I (we)acknowledge that I (we)am(are) responsible for the v0 m <br /> detail and accuracyof all information contained in this application (including an accompanyingschedule and I (we) <br /> PP ( 9 Y ) ( ) <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 [ of <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 in <br /> mises at any reasonable time for the purpose of inspection. m <br /> SIGN HERE <br /> 4 8/19/Ei <br /> (sign re f ownering contractor) (date � �� � ` � <br /> o: o <br /> o: o <br /> ZONING ADMINISTRATOR N o N T <br /> vt vu' oov,m <br /> TOWNSHIP PERMITS MAY BE REQUIRED 000Soo$In <br />