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Burnett County Office of Zoning Administrator m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS <br /> �J <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and v m <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- (D <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. o <br /> N w <br /> c ;? <br /> O ER Pleas Print) Contractor or Surveyor or Agent ' /' E <br /> d r <br /> Addressyi <br /> Address m <br /> •z�� c S, ,ni,re k I ��iC <br /> City,State,Zip Q4de City,State,Zip Code <br /> Telephone /'�(1� �7G -- In 4/1, Telephone � <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving ° b <br /> Sanitary -- Camping Unit <br /> Privy Subdivision c <br /> m <br /> /3 c� c c <br /> Structure Use: �� r `-vim — SAO i,pt-W Od� Q <br /> (family home/cabin,garage,addition, etc.) <br /> o v <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, 6 a <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 the owner. <br /> O <br /> o <br /> 3 <br /> .. p <br /> Z C, (/^\ <br /> 0 1 <br /> y� f <br /> C ��y <br /> I; <br /> 0 <br /> ro <br /> O p <br /> ✓ /' I VJ <br /> o-� <br /> Z <br /> M 0)M6 r-DDmy <br /> w' � wo �m3 <br /> p = <br /> O <br /> I(w eclare that this application(including any accompanying schedule)has been examined by me(us)and to the best of . S: ? ,� , 9 <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) ii D <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 <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 inspection. <br /> m <br /> SIGN HERE <br /> Ignat re of owner orb ' ing ontractor) (date) <br /> ZONING ADMINISTRATOR 11�� i ,V�'I'UC'I/,Lri/ - <br /> ONS+Nm <br /> Ut!s GA OON <br /> WNSHIP PERMITS MAY BE REQUIRED 8 605y <br />