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Burnett County Office of Zoning Administrator f 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 w -� <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- CM <br /> 3 n - <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- - (/) <br /> tith��jj State of Wisconsin. 5 m - .. <br /> M I G/I P9 L �ht h 9S c m o <br /> m <br /> OWNER(Please Print) Contractor or Surveyor or Agent F <br /> 81.10 Dir,- po ✓l _7f: m <br /> a <br /> Address Address g <br /> Li c_ Mv). -'ro S- <br /> City,State,Zip Code City,State,Zip Code <br /> Telephone Telephone to <br /> Permit(s)Applied for: 1 J <br /> New Building Filling/Grading <br /> Z <br /> Addition Moving C>Q o <br /> Sanitary Camping Unit s <br /> Privy Subdivision o_ U <br /> P ' <br /> N <br /> Structure Use: � �� 0 04I"ll o <br /> )(family homocabin,garage,addition,etc.) Z <br /> o <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). 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. 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. <br /> nA <br /> o gi, <br /> a o <br /> Z <br /> O <br /> RS <br /> s e m <br /> 0co <br /> o. <br /> � O <br /> J <br /> C, u, <br /> o <br /> 1 _n <br /> m <br /> r <br /> M N-0fn r DD W-0 <br /> m n ' nm nc m <br /> n nnS <br /> O J m <br /> Z O z 1 <br /> O J . <br /> �: m <br /> 0. �; m <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of 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) 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- <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the <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. <br /> m <br /> _ fn <br /> SIGN HERE C- <br /> si iatu of owner o in contractor)( 9 r) (date) E $ [ $ <br /> ZONING ADMINISTRATOR w-1 <br /> N N O V N <br /> in cn<nmoowm <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />