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0+�i' r ,:,y y) <br /> Burnett County Office of Zoning Administrator N m Z <br /> o <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> d o <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- <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 n ,) <br /> tions of the State of Wisco sin. ^` o P <br /> 5 d C <br /> /Vl qrska svAos 1 <br /> OWNER(Please Pr i t) Contractor oi-aurveyor or ant <br /> A� <br /> Address Address <br /> oli va /7 lwAl State, — <br /> Zip Code Qr� L� City, State,Zip Code <br /> Telephone — DO— 99-ia... -� <br /> .a <br /> e \ IG� ��� ZG�eY�u✓� Telephone <br /> Permit(s)Applied for: CC1l <br /> �, <br /> New Building '�-� Fillin rading <br /> Addition X --- oving o <br /> Sanitary Camping Unit c1 <br /> ^ o <br /> Privy Subdivision 0 <br /> N � i <br /> Structure Use: <br /> (family home/cabin, garage,addition,etc.) o <br /> m <br /> Directions for plot plan drawing: <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North (N). t p <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. <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 /> description o sormas onOL TpA 3 <br /> 1�l z Q <br /> o n <br /> 9� <br /> 0 <br /> _ <br /> If <br /> C,q�l. i�✓ �' a' <br /> Ut -� <br /> t � r <br /> V <br /> ) n <br /> J <br /> N <br /> O <br /> J <br /> _ <br /> 0 <br /> O <br /> 5p <br /> F <br /> T <br /> r <br /> N <br /> Z <br /> i i Z <br /> i <br /> r <br /> i <br /> w� L <br /> oon-.m <br /> m a< -nm ^;nm <br /> Z O : .� 1 <br /> 2 j on <br /> 0 : A <br /> o G <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all _ m <br /> information contained in this application(including an accompanyingschedule and I further declare that I recognize that <br /> PP C 9 Y ) 9 ? C <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a 'o <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized 'O <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> LN HERE <br /> (signs f owner or i ng contractor) (date) N <br /> o: o <br /> ZONING ADMINISTRATOR o o <br /> iJNOIV T <br /> TOWNSHIP PERM 1 MAY BE REQUIRED NN o m <br /> 0000000fmA <br />