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Burnett County Office of Zoning Administrator F o <br /> APPLICATION FOR — LAND USE — PERMITS = o <br /> TO THE ZONING ADOINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m 0 <br /> located as shdwn 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 /> tions of the State of Wisconsin. <br /> 0 <br /> f1'l: K Se I& i SLO f}U+�a-K c <br /> OWNER(Pleas Contractor Contractor or S�or Agent a E <br /> L£s oi2.`t�Prvn �hortnbwrc� F4[.R 54 �x �I-78d w <br /> Address Address a <br /> x7789 AODM J - S000✓lU( U3 S48ol <br /> City,State,Zip Code City,State Z p Code <br /> ,1 0nrner u); _548401 �e3S -74'Ft2 , N <br /> Teleph ne635 '78�t$ Telephone <br /> Permit(s)Applied for: I �' <br /> New Building PillinglGrading <br /> Addition Moving o <br /> anita _. _ Camping Unit <br /> Privy Subdivision o <br /> Structure Use: o O <br /> amily hoelcabl , garage,addition,etc.) o <br /> 0 <br /> a <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North (N). <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. i S <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 /> 0 <br /> 0 QQ <br /> a <br /> Z <br /> 0 <br /> ,q�Actf�p <br /> a <br /> w <br /> 0 <br /> 0 <br /> N <br /> � m <br /> m <br /> O 0 <br /> y i � <br /> m O <br /> Z <br /> o <br /> z <br /> s <br /> A rnvmrDDm� <br /> M C 0 > 0 ac m <br /> m av5o.monn — <br /> an70 <br /> O O �•2 1 <br /> T»E c m <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. I(we)acknowledge that I(we)am(are)responsible forti 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- F <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- <br /> cials charged with administering coAy ordinances or other authorized person to have access to the above described pre- <br /> mises at any(easonable time lor t <br /> Is purpose of inspection. <br /> SIGN HERE <br /> (sig ature of o ner or building contractor) (date) <br /> ZONING ADMINISTRATOR 1 I�Y�I C�rIT. J of fn-1 <br /> N in <br /> N U O O N <br /> M/1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 00of <br />