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Burnett County- Office of Zoning Administfator ; '01' £ o <br /> APPLICATION FOR — LAND USE — PERMITS 3- <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m c <br /> Cc <br /> 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 W'sconsin. w w <br /> I�/i///lJm /r =2 him sQeiCl <br /> m o <br /> OWNER(Please Print) live. Con actor or Surveyo or Agent n <br /> � � I.t/Gtsfibuin <br /> Address Addre s <br /> / 2'026 a0o%s, L10 u-- k�I .Sve3O <br /> City, State,Zip Code City,State - <br /> � <br /> Telephone Telephone pS^) <br /> Permit(s)Applied for. -i <br /> New Building Filling/Grading <br /> Addition Moving o �- <br /> Sanitary ✓ Camping Unit <br /> Privy Subdivision 0 (f1 <br /> m <br /> Structure Use: <br /> f (family home/cabin,garage,addition,etc.) o 0 <br /> a <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.I <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 o <br /> I Z <br /> 0 <br /> w co <br /> � c <br /> 0� <br /> r o <br /> N 6 <br /> 0 <br /> � \ m <br /> O O <br /> � . <br /> I L <br /> Z <br /> C) <br /> 0 <br /> Z <br /> p <br /> 7o mvNr DDWy <br /> m c .mmoo.cm <br /> n v,� o0on-. <br /> m n am ';Sy <br /> v ° cmo� 3 <br /> N z N O Zt <br /> d m <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of o: ; m <br /> my(our) knowledge and belief it is true, correct and complete. I (we)acknowledge that I(we)am(are)responsible fort is — [ m <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I ( e) O <br /> further declare that I(we)recognize that this information I(we)am(are)providing will be relied upon by the County of B11r. <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result oft e <br /> County of Burnett relying on this information I(we)am(are)providing in this application. I(we)agree to permit county o fi- <br /> cials charged with administering county ordinances or other authorized person to have access to the above described p e- <br /> mises at any reasonable time for the purpose of inspection. <br /> m <br /> I � i <br /> SIGN HERE <br /> (si lure of owpr or building rac or) (date) o o <br /> Oi i i o <br /> ZONING ADMINiSTRATOR <br /> N m <br /> p7Yt tittTNNOOtT <br /> TOWNSHI PERMITS MAY BE REQUIRED o080000vmi <br />