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Burnett County Office of Zoning Administrator o m 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 w <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 /> tionsof tate of Wisconsinin C <br /> . m m <br /> o <br /> OWNER(Please Print) Contractor or Surveyor or Agent n <br /> Address . y M� Address �5_y <br /> =° <br /> City,State,Zip Code City,State,Zip Code <br /> Telephone Telephone <br /> Permits)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit 'm <br /> Privy Subdivision 0 <br /> Structure Use: +k)rntE- I ° <br /> (family home/cabin, garage, addition, etc.) Z o <br /> o a <br /> m <br /> t. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North(N). (-1 .� 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 within300 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, yJ <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. tr< <br /> n 1 <br /> 0 <br /> a <br /> Z <br /> YtttovR 4�� Np�IO�' ^o'^ � U\ <br /> I \v <br /> IC> < j <br /> �0 �/�� y fs• T <br /> 124 <br /> o , <br /> 7 /Zf <br /> 4ir 23 <br /> 3o,r <br /> r <br /> R6,4-6 4; � <br /> � r x mvmraaEm <br /> 0 Q<aM =cm <br /> nn- <br /> m a� - nm ';ap <br /> a m E ? <br /> 00 �' 3 <br /> Cn [ A <br /> T» c m <br /> o : p <br /> o? c ? C <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of -0 : ; 'm i ? y <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) 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- <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the Q <br /> County of Burnett relying on this information I(we)am(are)providing in this application.I(we)agree to permit county offi. ?y? <br /> cials charged with administering county ordinances or other authorized person to have access to the above described pre- i <br /> mises at any reasonable time f e purpose of in ection. <br /> SIGN HERE <br /> (sig re of owner�orr)pgil I c ntractor) (date) <br /> ZONING ADMINISTRATOR <br /> NNN 00 <br /> TOWNSHIP PERMITS MA BE REQUIRED o0 00 <br />