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fir✓, (�7Y1i.�-', <br /> Burnett Qounty Office of Zoning Administrator 'o £ 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 v m <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 /> tionsthe State of Wisconsin. — > <br /> m�.r Ini 2Z l� uoi Cram � o <br /> OWNER(Please Printr? Contractor o Surveyor o Agent o- F <br /> SSS-�-. � � (< f�ou,t i I .�OX `Z�O <br /> Addr, AddrJ <br /> City, State,Zip Code City,State,Zip Code ' <br /> Telephone Telephone t <br /> Permit(s)Applied for: -1 <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit <br /> Privy Subdivision o <br /> N <br /> Structure Use: ° <br /> (family home/cabin, garage, addition, etc.) z o <br /> O V <br /> N <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 /> O <br /> 3 <br /> f 3 rT <br /> r, � z o <br /> , <br /> r;x <br /> Yo <br /> �6 <br /> � m <br /> � n <br /> 0 <br /> i a <br /> T <br /> CA Z <br /> Ali P <br /> el IV <br /> Cj <br /> /J MI <br /> o 3 <br /> In <br /> o <br /> ••..``o i [ c C <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of tJ'o[ 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) ' D <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 13 <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- <br /> mises at any reasonable time for the purpose of inspection. j':. <br /> m <br /> SIGN HERE I vE E E N <br /> Isi ure of owner r building contractor) (date) <br /> o: o <br /> b: o <br /> o; o <br /> ZONING ADMINISTRATOR in-n <br /> NNOIJ+-�Nm <br /> Ut V•Vt(TOOfT <br /> TOWNSHIP PERMITS MAY BE REQUIRED o000000vmi <br />