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' + <br /> Burnett County L « <br /> Office of Zoning Administrator f o <br /> APPLICATION FOR - LAND USE - PERMITS 3. <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. m o0, <br /> � O <br /> OWNER(Please Print) go <br /> � J Contractor or Surveyor or Agent o <br /> Sfe.v Lge leo'j - w <br /> Address Address g, <br /> U� <br /> City,State,Zip Code 11City,State,Zip Code <br /> Telephone Telephone <br /> m <br /> Permit(s)Applied for. oC <br /> 1 <br /> New Building Filling/Grading <br /> Addition - Moving 0 <br /> Sanitary Camping Unit <br /> Privy Subdivision 0 <br /> m <br /> Structure Use: 0 <br /> (family homelcabin,garage,addition,etc.) o o t\ <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 1 I <br /> the owner. <br /> 0 <br /> 0 <br /> -3 r <br /> a o <br /> Z <br /> 0 <br /> G _ <br /> Cn <br /> n d6- <br /> I y � <br /> j T,9 -� �9�4 3 S 6-1sT� f�1. <br /> n N <br /> m <br /> m m <br /> O 0 <br /> rn ,l � <br /> N <br /> Z <br /> O <br /> Z <br /> 9 <br /> I� <br /> � fnvrnrDDmy <br /> m c ww0ac_ m <br /> maaA <br /> a y' w w0 3 m 3 <br /> X : 2 Q <br /> O: O <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of <br /> m ou knowledge and belief it is true, correct and complete. I we acknowledge that I (we)am are responsible for the <br /> Y( d 9 P O 9 ) (are) P C?' r i 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 b the Count of Bur- r <br /> ( ) 9 ( ) (are) 9 P Y Y it <br /> Bur- <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the E pE <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 p <br /> mi % t any.reAsopabfi time forje purpose of inspection. <br /> SIGN HERE <br /> (siiggn�/ra of owner or building contractor) (date) <br /> M"7 <br /> ST <br /> Z NING ADMINISTRATOR �����" ' ��/ "�� �— ^° IV N O N n'i m <br /> �Uf(TNN OON <br /> TOWNSHIP PERMITS MAY BE REQUIRED $ N <br />