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Burnett County Office of Zoning Administrator co m f o <br /> APPLICATION FOR — LAND USE — PERMITS z3 <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- 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 the State of Wisconsin. w m <br /> JAMES STEEL MELVIN J. FERGUSON C = p/ o <br /> OWNER(Please Print) Contractor or Surveyor or Agent o. <br /> 1032 4TH . HCR 59 BOX 478-D d <br /> Address Address g <br /> HUDSON. WI 54016 SPOONER, WI 54801 <br /> City,State,Zip Code City,State,Zip Code <br /> (715) 635-7482 <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> t <br /> New Building X — Filling/Grading ! <br /> Addition Moving o <br /> Sanitary X Camping Unit <br /> Privy Subdivision 0 <br /> w <br /> Structure Use: CABIN ° <br /> (family home/cabin, garage, addition, etc.) o 0 <br /> v <br /> m <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North(N). f <br /> .� 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. j <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 /> rn <br /> n <br /> 0 <br /> 3 � <br /> 9 O <br /> Z <br /> o� �l <br /> ATTACHED Q m <br /> n <br /> N <br /> Ul <br /> m <br /> O O <br /> P � <br /> C ' m <br /> m <br /> Z <br /> 0 <br /> Z <br /> o v< > > on .A <br /> wH o' 3 <br /> o: W n 1 <br /> « 2i 1 m <br /> I we declare that this application(including an accompanyingschedule has been examined b me us and to the best of <br /> ( ) PP ( 9 Y ) Y O o f E i �^ E <br /> my(our)knowledge and belief it is true,correct and complete. I(we)acknowledge that I(we)am(are)responsible for the n 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- d <br /> nett Wisconsin in determining whetAr to issue a permit. I (we) further accept all liability which may be a result of the <br /> County of Burnett relying on this in r ation I(we)am(are)providing in this application.I(we)agree to permit county offi. <br /> cials charged with administering c un y ordinances or other authorized person to have access to the above described pre- <br /> mises at any reasonable time or t purpose of inspection. <br /> m <br /> SIGN HERE D o: <br /> ( g a of ow r or building contractor) )_. ' b S ' ' <br /> 1 P i o: E <br /> ZONING ADMINISTRATOR ` -n <br /> JUN _ VNO m <br /> TOWNSHIP PERMITS MAY BE REQUIRE ��I NNS o <br />