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Burnett County Office of Zoning Administrator ; f o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> _ am o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m c <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 /> tions of f WiscgOsin�� O <br /> �R////rf�__,,��., w m <br /> c S? <br /> m <br /> OWNER(Please r nt/) Contractor or Surveyor or Agent a <br /> m <br /> Address Address m �- <br /> i <br /> City,State,Zip Code <br /> City,State,Zip Code <br /> Telephone Telephone �J <br /> Permit(s)Applied for. <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit <br /> Privy �/}/L/ Subdivision <br /> pg't" <br /> Structure Use: � 0 <br /> v <br /> (famil home/cabin, arage,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. <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 /> O <br /> 0 <br /> 3 <br /> a o <br /> Z <br /> O <br /> t <br /> co <br /> or <br /> a <br /> < w <br /> T. <br /> 2 <br /> m <br /> o 0 <br /> Z <br /> P <br /> z <br /> � a <br /> M 0)100r­D Dm-0 <br /> m cn.mmoacm <br /> 0 a< » 0a- <br /> m <br /> 0 O i500 <br /> 1 <br /> O <br /> N: M <br /> w �' m <br /> O <br /> DE 0 : <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 <br /> my(our) knowledge and belief it is true, correct and complete. I(we)acknowledge that I (we)am(are) responsible for the <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we) n 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 <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- 'N <br /> mises at any reasonable time for the purpose of inspection. a <br /> SIGN HERE <br /> (si re of owner or buil co Ira tor) (date) b <br /> ZONING ADMINISTRATOR <br /> N N O NP 9 N M <br /> � �Il NN(TN 00[Tm <br /> OWNSHIP PERMITS MAY BE EQUIRED � to <br />