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Burnett County Office of Zoning Administrator m m o <br /> APPLICATION FOR — LAND USE — PERMITS 7W <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and - 00 <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. m <br /> John Hoeft Donald Daniels ; N 0 <br /> OWNER(Please Print) Contractor or Surveyor or Agent °' r) f <br /> 3301 Golf Rd. PO Box 316 d h <br /> Address Address <br /> Eau Claire, WI 54701 SirAnr WT 54879 <br /> City,State,Zip Code City,State,Zip Code f <br /> 715-833-1761 612-349EE22 o <br /> Telephone Telephone ) <br /> Permit(s)Applied for: 1 = <br /> New Building Filling/Grading (D <br /> Addition Moving O �* <br /> Sanitary x Camping Unit <br /> Privy Subdivision 0 <br /> N <br /> Structure Use: <br /> single family home <br /> v <br /> (family home/cabin, garage, addition,etc.) o 0 <br /> 9 <br /> N <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North (N). .zc 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. 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. 0 W <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 /> A <br /> O <br /> 0 <br /> 3 r- <br /> a ) o <br /> Z <br /> C+ <br /> SEE ATTACHED PLAN o <br /> h <br /> m 0 <br /> 0 I n � <br /> Se a ` <br /> 0 <br /> 7 w s <br /> C <br /> io14 <br /> 0 <br /> co V <br /> p 0 Ro <br /> w � � <br /> AO <br /> M <br /> La <br /> O <br /> < <br /> 1 a <br /> 21 <br /> o 0 <br /> rr <br /> 'm <br /> Z w <br /> 0 <br /> Z <br /> N _ <br /> lD ]7 <br /> N <br /> A <br /> N <br /> 0 <br /> O <br /> C+ <br /> m c�mm>nc�V <br /> m a� 3-n 00 <br /> rn `Z � 00�0 <br /> Z o E Z <br /> M <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 O <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) <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 o: <br /> s <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- i i : a <br /> mises at any reasonable time for <br /> �(the <br /> �/purpose of inspection. <br /> Ck/ v E <br /> SIGN HERE 6/5/90 <br /> o: <br /> (sig of owner or u' ing contractor) (date) <br /> ZONING ADMINISTRATOR -° d <br /> P, in obpm <br /> m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 8 88co) <br />