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Burnett County Office of Zoning Administrator ; o <br /> APPLICATION FOR — LAND USE — PERMITS 3_ <br /> s t� <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and v 00 _a <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- ry <br /> tions of the State of Wisconsin. <br /> an �iM a o <br /> OWNER(Please Print) Contractor or Surveyor or Agent °- F <br /> f y 2 7� Cam adv ,dir.. <br /> Ad r?USs Address <br /> eh ''i-al'irie 14V Ss.3 r i <br /> Citytatep C' City,State,Zip Code v <br /> JJJ i2O <br /> Te e�phone Telephone ti <br /> Permit(s)Applied for: <br /> New Building X Filling/Grading - <br /> Addition Moving <br /> v <br /> Sanitary Camping Unit <br /> Privy Subdivision 0 <br /> Structure Use: ✓-� 4 ��/ /r` /���p x r�0 T f �V f 0 <br /> (family home/ bin, garage, addition,etc.) o o <br /> 0 Z <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North (N). 0 <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. o , <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. 4I <br /> 0 <br /> To <br /> Z <br /> 0 <br /> iU SIC 17,�6 ,• tv N <br /> s i ve r Oaks r < <br /> �- <br /> a 72 sic, s. u• `�^ i <br /> oma' i,6CA, %aXr�Gi � NI <br /> s tofa�e 71 f v <br /> co <br /> ( o <br /> —__©ver 0ueIr <br /> �._ 300fr30ft <br /> to road to ri uer <br /> Z <br /> m <br /> Z <br /> 0 <br /> Z <br /> D <br /> W G�N Nnn� D <br /> N RK, nnA <br /> a <' 91c6i033 <br /> w Z '0o =m <br /> Z o f '0 <br /> '� : i 1 <br /> P E <br /> CZ i M <br /> N m <br /> Cc Q <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of o: m <br /> my(oyr)knowledge and belief it is true, correct and complete. I (we)acknowledge that I(we)am(are)responsible for the m <br /> detailandaccuracy of all information contained in this application (including any accompanying schedule) and I (we) `^E ' 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. ' r; <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the n i0' <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- ` `N' <br /> mises at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> na re of own ilding contractor) (date) ` o' <br /> ZONING ADMINISTRATOR ✓ N N o N m <br /> Nm <br /> m <br /> TOWNSHIP PERMITS MAY BE REQUIRED 888o et/1 <br />