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Burnett County Office of Zoning Administrator c 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 a �w <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 3 0. <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- <br /> tion of the State of Wisco sinrc <br /> . / w w <br /> a,nn�5 .4, / h lG UGi �ih1 Ct)CE m <br /> 0 <br /> (Plea Print) Contractor or Surveyor d gent o. 0 � <br /> Ad ress Addres <br /> octi"P)4 �ak� ASNK ,1��.Ss93a %►�h �./. - she <br /> Cit�ate,ZWCode City,State,Zi p C3ode 5/g <br /> Telephone Telephone Fb <br /> Permit(s)Applied for: 1 <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit o <br /> Privy Subdivision J <br /> T N <br /> Structure Use: <br /> (family homelcabin, garfige,addition,etc.) z o <br /> 0 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). -c. (N <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. O <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and dated by *the owner. <br /> 0 <br /> LokB / . a <br /> 'R N o <br /> Z <br /> o <br /> r � <br /> 114 lV <br /> VI n <br /> C <br /> J <br /> O <br /> J Q <br /> A160w <br /> aLO Add- <br /> �df (rn <br /> Z <br /> Z <br /> �3v• See SA+ui�� �+"j'^�f� <br /> Mo <br /> m a�a0. m a <br /> =am <br /> "cwo'J3 <br /> n Z m p M n <br /> Z o: 'Z : : i <br /> o J , <br /> n € 2 m <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of9 <br /> my(our) knowledge and belief it is true,correct and complete. I (we)acknowledge that I (we)am (are)responsible for the �: i 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- a; <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the aE <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 /> mises at any reasonable time for the purpose of inspection. m ,� <br /> SIGN HERE <br /> (signal f owner or bui contractor) (date) 'o .o o <br /> n <br /> ZONING ADMINISTRATOR ' <br /> V N O N <br /> NN TN m <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />