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Burnett County Office of Zoning Administrator w -w o ooz <br /> '- 3 <br /> APPLICATION FOR — LAND USE — PERMITS z 3 o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 3n <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- <br /> tio /the Stgt9W�nsi9 m w <br /> ��,i�/ �� �� N m <br /> C <br /> Contractor or Surveyor or Agent E <br /> MAV <br /> OWNER�PI se P?� n <br /> Addres Address <br /> N/ V&1,ALAI X5037 <br /> 77 <br /> City, tat�eq ip c6d/Q_ �7 City,State,Zip Code Q <br /> �i�C��c�O Y' / � !" � sL�m� <br /> Telephone- Telephone -�F— /n <br /> Permit(s)Applied for: "� (xl �/ J <br /> New Building Filling/Grading �.�� <br /> Addition Moving o <br /> Sanitary ✓ Camping Unit N <br /> Privy Subdivision o <br /> Structure Use: Caves//7 0 ((; <br /> (family home/cabin, garage, addition,etc.) Z QJ <br /> o <br /> a <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(DF). 4 <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, 9-)river or stream, if applicable. J <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 /> n 5, <br /> 0 <br /> a p <br /> Z <br /> 0 <br /> ,�1L�� N <br /> /�'t/1 j \ v <br /> IIVVFV/" <br /> w <br /> N <br /> O <br /> � N <br /> N <br /> m 0 <br /> O 0 <br /> N^ � <br /> S ( <br /> m <br /> N <br /> Z <br /> O <br /> Z <br /> 11 <br /> a mvtnr D D ca a <br /> m c .m m 0 a c <br /> 0 c< 000 a—m <br /> m nuc am ';ny <br /> Z O <br /> Q <br /> N: m <br /> 0 : [ O <br /> c ' C <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) 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 admi ' ring county or nan as or other autho ized person to have access to the above described pre- <br /> mises at any reason e e for the purppse f inspe n. m <br /> m <br /> w <br /> SIGN HERE fry//n. ,u <br /> V: O <br /> (s' na re o owner ontractor) (date) i <br /> o o <br /> o <br /> ZONING ADMINISTRATOR s fn T <br /> mNooPm <br /> TOWNSHIP PERMITS MAY BE REQUIRED oo S0000rmil <br />