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Burnett County Office of Zoning Administrator ; 3 f o <br /> APPLICATION FOR — LAND USE — PERMITS o <br /> z <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 /> 3 <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- <br /> ti sof the State f Wisconsin. _ <br /> � oo, It YY wyi - i rJ <br /> m p <br /> OWNER(Pie e P i ) _ _ Contractor or Surveyor or Agent n <br /> uxi <br /> Address M //�L- m� Address m <br /> City,State„Zii lads J _ � City,State,Zip Code <br /> �C�J o� <br /> Telephone Telephone L,(-) <br /> Permit(s)Applied for: <br /> New Building '/ Filling/Grading <br /> Addition Moving o <br /> Sanitary •� Camping Unit —� <br /> Privy Subdivision rt— <br /> ��� 1 � w J <br /> Structure use: ° J <br /> (family home/cabin, garage,addition,etc.) o 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. o <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 /> U�9aS a <br /> Z <br /> ° <br /> EA <br /> 3a T off. <br /> y <br /> Mfr X F m <br /> �-�r <br /> 5 �yX�2� /' X05` seflos< k <br /> AbF 24- <br /> C b F 36 Prc, Ile4zd �r ��� o� <br /> Z <br /> � O FT- 'fC <br /> J t.' FF m <br /> m a•c — nm ';a9 <br /> E a Zw0 'n <br /> 1 O O i i 50-Z <br /> C ~ ui i : m <br /> $ fd� > <br /> L�9KE s 2C <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of o i `: m iy <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) <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 :o <br /> County of Burnett relying on this information I(we)am(are)providing in this application.I(we)agree to permit county offi- 4 <br /> cials charged with administering county ordinances or other authorized person to have access to the above described pre- <br /> mises at any reasons time for the purpose of inspection. <br /> SIGN HERE o E ? o <br /> (sign re of owner or b'din ontractor) (date) b: $ <br /> o: <br /> ZONING ADMINISTRATOR - g <br /> T <br /> OWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 <br /> f <br />