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Bumett.County Office of Zoning Administrator M f o <br /> APPLICATION FOR — LAND USE — PERMITS 3_ <br /> d o <br /> a <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m 00 <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 3 <br /> nett County Land Use Ordinance,Sanitation Code,and with all othe plicable County Ordinances and the laws and regula- ( R <br /> tion of e Ste Wiscor�gi n�I \ w d v <br /> N� a1 L_J <br /> O ER Please P(int) Contractor or Surveyor or Agent F <br /> "I�,�� tuadencnc m �A <br /> Apd ess /� Address �= <br /> City,State,Zip Code City,State,Zip Code <br /> Telephone Telephone <br /> V� <br /> Permit(s)Applied for. <br /> New Building Filling/Grading C7 <br /> Addition Moving o <br /> Sanitary Camping Unit <br /> Privy Subdivision 0 <br /> Structure Use: ►^'�'� o� X �U o <br /> v <br /> (family home/cabin,garage, addition, etc.) a d <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. Dir; <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 /> v o <br /> Z <br /> O <br /> „I <br /> C co <br /> ltl V <br /> t O. <br /> nCl) <br /> �rW O <br /> w <br /> see o 0 <br /> w Q-) <br /> er 111V 3 <br /> _ See <br /> Z <br /> 0 <br /> Z <br /> 70 7tvN�DDmy <br /> n &<—o ORE.m <br /> mnuc - n m 51 n y <br /> a < ' d C O O ; <br /> o <br /> n O m <br /> O O ' M <br /> w € [ c m <br /> n : E 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) E 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 /> o: <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- E a E <br /> mises at any re le time for the purpose of ins tion. -n <br /> SIGN HERE <br /> (si re o ner or b d' ig contractor) (date) <br /> ZONING ADMINISTRATOR <br /> tN1�tN1�N(NTO N <br /> TOWNSHIP PERMITS MAY BE REQUIRED o$$oS a <br />