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eett C"nty ' Office of Zoning Administrator m d c o <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> z o ) <br /> fO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m <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- — J <br /> tion the State of Wi cousin. w m <br /> VO-12lD/' o <br /> OWWIER(Please Print) Contractor or Surveyor or Agent <br /> Ad ess Address <br /> �re�e -le, /X/T 57/237 C- <br /> CItle!t;�Zi 7 J 837, / city,state,Zip Code <br /> Telephone Y Telephone <br /> Permit(s)Applied for. <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit <br /> Privy Subdivision 0 <br /> Structure Use: <br /> (fa ,y homelca garage,addition,etc.) Z o <br /> o a <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). ��� t <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. y-� 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. U'I <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 /> O <br /> 3 <br /> a o <br /> 2 <br /> CD <br /> ° <br /> c,u <br /> J <br /> J d . <br /> � a <br /> 0j N <br /> 00 <br /> N <br /> m ° <br /> 0 <br /> N � <br /> I � <br /> l0 <br /> Z <br /> O <br /> Z <br /> 9 <br /> m c�oNimoacm� <br /> v < d c w 0 3 <br /> w W <br /> Z O m <br /> O : : W 1 <br /> �^^ <br /> 01 M <br /> C 1 O <br /> O: O <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of <br /> 0 - <br /> my <br /> imy(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) !` 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- E o <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 /> mass at any reason le time for the purpose of inspection. m <br /> m i i E-nE i <br /> SIGN HERE <br /> (si lure of er o uil ing contractor) (date) E o <br /> Q $E E ? o <br /> ZONING ADMIN STRATOR ro N c N N m <br /> TOWNSHIP PERMITS REQUIRED o000000umi <br />