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Via-4401110 <br /> Burnett County Office of Zoning Administrator ; 0 f o <br /> 3. J <br /> APPLICATION FOR — LAND USE — PERMITS z y o UJ <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- <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 o <br /> tions of the State of Wisconsin. — <br /> rI L M c°f A-nl �I N <br /> OWNER(Please Pri t) contractor or Surveyor or Agent <br /> �t /ODD A <br /> Add /� Address <br /> City,State,Zip Code -( City,State,Zip Code <br /> Telephone Telephone i Xl <br /> Permit(s)Applied for: _ \' <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit <br /> Privy Subdivision ° <br /> J <br /> �� N <br /> Structure Use: <br /> 4dd1fi1�1)1 DACE - lUY1�()IP�lI-� ( tSE <br /> o l <br /> (family home/cabin, garage,addition,etc.) 3440 ;7(t X/�C1 Z 'o <br /> o a <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. <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 O <br /> the owner. <br /> O <br /> 0 <br /> 3 r <br /> a o <br /> Z <br /> O <br /> an <br /> �e � �hQoL <br /> W N <br /> � a <br /> TA1S peen,, t5 Trot shc,decA wreck- %howAl aS <br /> ho o�� �,'�-ro.�, on. A{fac-j�ecf `Plof' Plr.w otiI U o <br /> I� p rn <br /> m <br /> r ?he AMC sl.o'UN o.Of, �w{ure add� Ffoni oN pl°f' �� 1� <br /> ploou Ljo,, p� re�j tire– 0. L)(Xi^IoN� eLs /� t"O� ld V I <br /> /uc+ meet Se-1.6,4�k +^e�u�rew�e lS esFubl.s� 6� <br /> -AluCAIISQ o�cltrtaL2 0.rr<en ffile^+ o^' 3t 1� 7tIagIS. I ' � <br /> m I� <br /> 13533 I SS w'e�j Z <br /> �� prt�lA�� bks dt <br /> 13w <br /> mf`c Www o ac�� <br /> O J f0 <br /> Z O : -1 <br /> co : M <br /> ��� 7y/w.lG/i/1 �1 Q/Ct-N G!DDI UC o l 1'C��d t,4�[iI eP o C <br /> I(we)declare that this application(inc g i any accompany�ing schedule)h4 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- -I a <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 pre- <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. m [ <br /> SIGN HERE <br /> (sig r of owner Ao ng c clot) (date) [wy o 0 <br /> ZONING ADMINISTRATOR '^C - N N O IV N M <br /> Npo ossa$ofm/1 <br /> TOWNSHIP PERMITS MAY dREQUIRED tl <br />