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Burnett County Office of Zoning Administrator ; m f o <br /> APPLICATION FOR — LAND USE — PERMITS3- o L <br /> z <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m n <br /> c <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 3 <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- <br /> tions of a Sta of Wi onsin. / H m <br /> yOWNER t) Con c r•�r Su a or r Agent �- 3E <br /> 3� .�s�oNe Cit s'. Y� ��7 C�s$P.f�, �,tkd4 D<� m <br /> Address Address l <br /> D n pra HI�vl� � a2NtQ .f SL 0 3Z ST� <br /> City,State,Zip CodeS o i,b city,TZ cos 27- 6 ( I ok i <br /> I <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit F <br /> Privy Subdivision <br /> w <br /> Structure Use: I o <br /> (family ome a in, garage, addition,etc.) o 0 <br /> v <br /> m <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(OF). <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 /> UR <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 /> 0 <br /> If 3 <br /> a o <br /> 1 � 8 Z <br /> Ir� <br /> \ c <br /> w <br /> o <br /> NNc ' <br /> �� oW <br /> ro <br /> 0 0 <br /> 3or b <br /> 0 <br /> y �o <br /> �{ 1 <br /> 3a , SSI <br /> — rnrn�>>03 <br /> 00 Ca on n 00 rn <br /> a <• d <br /> Coo 5,5,3 <br /> p <br /> oi i m <br /> Z R.z 1 <br /> eo/ Cc <br /> o: <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 them <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- j <br /> Q <br /> nett Wisconsin in determining whether to issue a permit. I (we) further-accept all liability which may be a result of the : ;m <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 pur ose of inspection. 'I <br /> SIGN HERE ��— <br /> v: <br /> o: <br /> (Sig ure owner orb ' ontractor) ( late) /��.1y�. <br /> ZONING ADMINISTRATOR 1 <br /> N N O J N n <br /> PPPPOOPm <br /> TOWNSHIP PERMITS MAY BE REQUIRED 8$ 8 9 <br />