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Burnett County Office of Zoning Administrator coo 0 o <br /> APPLICATION FOR — LAND USE — PERMITS - 3. <br /> Z2 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and � <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 3 n 0 <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and reguia- o <br /> tions of the State of Wisconsin. w m <br /> w <br /> n O <br /> OWNER(Please Print) /) Contractor or Surveyor or Agent o m <br /> C,�rueARofLtE Ittilc,Pr�irt <br /> Address Address <br /> 1 o o AJ- EI M 1,�e�-, -1,4L- Lgo ?A SEPTIC & EXCAVATION (v`l <br /> Cit State,�Z,ip Code City,State,Zip Code 59, Box 478d 1 <br /> es t�LFl i n eS z tL to ooi 8 Spooner, VA 54@01 <br /> Telephone Telephone (715)M7482 t <br /> Permit(s)Applied for: 1� <br /> New Building — Filling/Grading <br /> Addition Moving o <br /> Senna — Camping Unit (p <br /> Privy Subdivision <br /> 0 <br /> Structure Use: <br /> (family home/cabin, garage, addition,etc.) o v <br /> m <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North(N). ,e 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. UP 0 <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, O <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 (n <br /> ys <br /> Z <br /> CO <br /> a <br /> fj a <br /> Ir� � V\ � ✓•J 1 ' 0 I <br /> 0 <br /> i <br /> 0 <br /> � y <br /> m <br /> oLy i <br /> I0 <br /> IV <br /> L ar , <br /> � P <br /> P <br /> Z <br /> }� 9 <br /> �1 <br /> m n� ''iim any <br /> ur 'Z y O i m <br /> N <br /> y: : y <br /> rF�n E c E m <br /> X03 n : 0 <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 the �; m <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we) <br /> further declare that I(we)recognize that this information I(we)am(are)providing will be relied upon by the County of Bur. `: o <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 thea � ' <br /> mises at any reasonable time for the purpose of inspection. m <br /> SIGN HERE II I ' o i i o <br /> (signature of owner or build' g c kt ) MAy a 'I I �Ji <br /> ZONING ADMINISTRATOR r roo"—8 N m <br /> TOWNSHIP PERMITS MAY BE REQUIREQ o000000tmil <br />