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Burnett County Office of Zoning Administrator f Z <br /> APPLICATION FOR — LAND USE — PERMITS 31 ' <br /> z �, s L <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and - c <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 /> tio f the State Wisco <br /> LA <br /> NER(Plea Print) CoC�lor or Surveyor or Agent n £ <br /> Are Addr ss <br /> City State,Zip Code City,State,Zip Code <br /> Telephone Telephone �f <br /> Permit(s)Applied for: vn�1 <br /> New Building Filling/Grading k/) <br /> Addition Moving o <br /> Sanitary Camping Unit <br /> Privy Subdivision 0 <br /> m <br /> Structure Use:l 44L 0Q4/A✓ 0 <br /> (family home/cabin, garage, addition,etc.) z o <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. <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 /> n <br /> RooNL�f La KE �� � NCy J.>1KL 2ooN� yp�t z 0 <br /> — - - 1Q11— <br /> 0 <br /> Ner ro .SCALE <br /> S'rrtee.be <br /> n <br /> O a4_ <br /> v <br /> V �/— O 1 <br /> p / ox/ I �s <br /> ya=--- <br /> �- li-g9 <br /> se Pr � <br /> � i� �M <br /> / ' WELL , 't- <br /> i.�p� 60 <br /> Z <br /> I � 9 <br /> i <br /> �I <br /> l � f <br /> I o v > > o Q O m <br /> m n� n' nag <br /> 9 <: '5 C W O <br /> wOOtO <br /> l <br /> : �o <br /> «€ m <br /> To WMS N,P /to.4 ut: i o E Q <br /> of [ E C <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of <br /> my(our) knowledge and belief it is true, correct and complete. 1(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) V ' ''N 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 /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the � ' ` ?cf <br /> County of Burnett relying on this information f(we)am(are)providing in this application.I(we)agree to permit count offi- <br /> cials E: <br /> cx. f <br /> charged with administering county ordinances or other authorized person to have access to the above described pre- ` `0 i <br /> mises at any reasonable time for the purpose of inspection. - <br /> m <br /> SIGN HER A10 <br /> (sig of wneror ingcontractor) (hate) o: o <br /> l? op <br /> ZONING ADMINISTRATOR <br /> [T fT Ut IT O N <br /> TOWNSHIP PERMI S MAY BE REQUIRED <br />