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Burnett County Office of Zoning Administrator ' s o <br /> APPLICATION FOR — LAND USE — PERMITS m 3 <br /> z s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 'u w <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 applicableI_r County Ordinances and the laws and regula- - <br /> tior)}s(�of the State/of�lWislconsin. ( p <br /> OW ER PI ase Print O <br /> ( ) Contractor or Surveyor or Agent E <br /> ox I/C 70 0 <br /> Address Address <br /> City,State,Zip dode City,State,Zip Code <br /> is- � yd9 <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving <br /> O <br /> Sanitary Camping Unit <br /> 1 <br /> Privy Subdivision o <br /> / n m <br /> Structure Use: G f,a- C o <br /> (family home/cabin, garage,addition,etc.) Z <br /> O <br /> a <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. r <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 /> a <br /> 'R 0 <br /> Z <br /> 0 <br /> A!1' rr�� I n <br /> &C. �SOC.; Ori 1 Are) N <br /> n <br /> 1 y <br /> N <br /> O <br /> = co <br /> N <br /> m n <br /> O p <br /> r—Q)w^ _ <br /> 1 v � <br /> ICI Z <br /> L � <br /> Z <br /> O <br /> Z <br /> m c�nNi mtDinmm <br /> m m an <br /> 9 <br /> a y ZPobm3 <br /> m <br /> o ' c i C <br /> I(ye)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of S, - 'm : ? - <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) i.� p <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- - <br /> cials charged with administering county ordinances or other authorized person to have access to the above described pre- imiE <br /> mises at any reasonable time for the purpose of inspection. T ` '• ' <br /> � E <br /> GN HERE <br /> O's igto a of owner or wildingcontractor) (date) a c <br /> 0 <br /> NG ADMINISTRATOR i.» nfni <br /> U U io O N <br /> 68000 <br /> OWNSHIP PERMITS MAYBE REQUIRED J 0 <br />