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Burnett County Office of Zoning Administrator ; m E o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and - <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> . s regula- <br /> tiMIote State 5T <br /> 3a <br /> 'I- �1 <br /> m o <br /> OWNER(Please Print) Contractor or urveyor or Agent o. <br /> 14 2- -3 fc r rYlGr 1V d _ <br /> Address Address = <br /> EdNn �rr�r( e MN 5534 <br /> City,State Zip 4�Code 7 —D� �� City,State,Zip Code <br /> Ihiz,� <br /> Telephone Telephone h� <br /> Permit(s)Applied for: �- <br /> New Building Filling/Grading <br /> - <br /> Addition Moving O <br /> Sanitary Camping Unit <br /> Privy �� Subdivision <br /> Structure Use: <br /> (family home/cabin, garage, addition,etc.) Z o <br /> o v <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 /> O <br /> 3 r <br /> a o <br /> Z 4 <br /> NW), NF <br /> 7, <br /> t � P <br /> 41 <br /> 1 <br /> _ J <br /> rn <br /> 0 0 <br /> w <br /> T <br /> 13 <br /> Z <br /> 0 <br /> Z <br /> 11raaawy <br /> m <br /> m -am any <br /> a cmo� 3 <br /> N Ii N O m m - <br /> N_ <br /> M <br /> ui i 2 i m <br /> c : o : O <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of 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) t3 <br /> further declare that I(we)recognize that this information I(we)am(are)providing will be relied upon by the County of Bur- ;oE <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the n <br /> County of Burnett relying on this information I(we)am(are)providing in this application.I(we)agree to permit county offi- i i i i <br /> cials charged with administering county ordinances or other authorized person to have access to the above described pre- i ? 2 i '- <br /> mises at any reasonable time for the purpose of inspection. m ' <br /> mi '"i <br /> SIGN HERE -`^"m�� <br /> (si re of owner orb in contractor), (date) o <br /> m �€ $ <br /> ZONING ADMINISTRATOR <br /> fJN INm <br /> u U N O O O <br /> m <br /> OWNSHIP PERMITS MAY B REQUIRED o 0 0 0 0 o vi <br />