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Bur. .ounty Office of Zoning Administrator w 0.1 o <br /> APPLICATION FOR — LAND USE — PERMITS -0 3 ' <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and - 00 <br /> c <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 3 ii <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 /> SNo��ti/vSPoee-Ts &jPV7Wi2, KI c.%,) tvo/JS7-, <br /> OM(Pleas Print) Contr,a�fo_r or Surveyor or Agent a -� F <br /> Y O� <br /> Address Ad ress m <br /> City,State,Zip Code y City,State,Zip Code ' ` <br /> Telephone Telephone <br /> Permit(s)Applied for: V\ _ <br /> New Building — Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit i <br /> Privy Subdivision o <br /> Structure Use: ° <br /> (family home/cabin,garage,addition, etc.) Z o <br /> 0 0 <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 (OF). <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. <br /> 3 r <br /> v o <br /> u, <br /> c <br /> 'a <br /> d o <br /> =U 0 y <br /> N � <br /> » If r\ <br /> IC <br /> 1 � <br /> T <br /> R � <br /> Z <br /> 0 <br /> Z <br /> 9 <br /> ]s rnvvir DDW� <br /> n v< » on- <br /> m nuc nm ^;ate <br /> Z o': m0 : 1 <br /> f 2 m <br /> C) <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of �o <br /> jj <br /> my(our)knowledge and belief it is true, correct and complete. I (we)acknowledge that I (we)am(are) responsible for the i iAE i m <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and <br /> further declare that I(we)recognize that this information I(we)am(are)providing will be relied upon by the County of Bur- a [ <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of theme <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 a of inspection. ' [ <br /> SIGN HER lU�� o2 <br /> (signall <br /> of owner or 'din contractor) (date) <br /> o: o <br /> ZONING ADMINISTRATOR 11f ^ ` ` <br /> N N O N P N <br /> fi WNSHIP PERMITS MAY E R QUIRED 88800 <br />