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0-7.7 - <br /> Burnett County Office of Zoning Administrator 0 m o p <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> d o <br /> z <br /> TO TFriE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and v w <br /> located as shown 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 /> ti ns of the State of Wisconsin. <br /> / o <br /> �yr�Q/FS L1j„"1'1y S6N1,141 LA0 Self Clrc� Pec�pt�c m W <br /> OWNER(Please Print) Contractor or Surveyor or Agent ° £ <br /> E87a 1cu�r 74411- m <br /> Address Address <br /> �TA�� r Mg . S.So'Jy I J <br /> CitC s te,Zip Code City,State,Zip Code <br /> J-/]-Hb.Z -YSa? <br /> Telephone Apo/7700 6-19- 144yOba'4<AP Telephone I <br /> Pi9urN: y. <br /> Permit(s)Applied for: I , <br /> V <br /> New Building Filling/Grading <br /> Addition Moving <br /> Sanitary _ Camping Unit m v J <br /> Privy Subdivision - o' - <br /> RI?stc(p-rKe /`Y Gam` add 1 abeJtgsr-. 1 y <br /> Structure Use: t /�+- 0 <br /> (family home/cabin,garage, addition,etc.) Z <br /> 0 <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 /> 0 1 <br /> 3 <br /> o <br /> �y O <br /> N <br /> a <br /> c <br /> n <br /> y <br /> J <br /> 0 <br /> m <br /> m <br /> � o <br /> N � <br /> l\.1 <br /> T <br /> Z <br /> 0 <br /> Z <br /> >a "� <br /> n Q� � oon- m <br /> z2 <br /> �SeeParn tJ I aq o Tf �c> Snow / 1- f &83 r ' ? co E m <br /> n p O <br /> 8 i c P C <br /> pi <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 for the ? m <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we) '^E ' t3 <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 is <br /> County of Burnett relying on this information I(we)am(are)providing in this application.I(we)agree to permit county offi- i :q <br /> cials charged with administering county ordinances or other authorized person to have access to the above described pre- ' `'i <br /> mises at any reasonable time for the purpose of inspection. <br /> m <br /> SIGN HERE <br /> (sig ure owner or building on ractor) (date ` o ` o <br /> �O <br /> GE <br /> ZONING ADMINISTRATOR <br /> / IVNON� m <br /> PN TNO <br /> N <br /> TOWNSHIP PERMITS MAY REQUIRED 00000 <br />