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nt 666)Y� , <br /> Burnett County Office of Zoning Administrator 'Wo i3 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 m 00 <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 3 Co <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- <br /> do s of the State of Wisconsin. +y <br /> G C e 'P r J611F liw s 4r /Cn �d ltT � c e. <br /> m <br /> OWNER(Please Print / Contractor or Su eyor or Agent n £ <br /> Address /)ddress <br /> yr J) 6NP,'.(d?/l <br /> ity,State,Zip C City,State,Zip Code <br /> _ 1 Q <br /> Telephone Telephone <br /> ( <br /> Permit(s)Applied for: <br /> New Building FillinglGrading r <br /> Addition Moving o �- <br /> Sanitary — Camping Unit <br /> Privy Subdivision o (� <br /> Structure Use: d'� ✓ZC'�t y'n.� �'?P�� �.�(.�l I.�f.1 L.l.�I 0 <br /> (family homelcabin, garage, addltjon, etc.) I Z o <br /> P ^J <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. "' rc <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 c t <br /> the owner. <br /> O <br /> 0 <br /> 3 r <br /> a o <br /> Z <br /> 0 <br /> ~ ur IM1 <br /> ' C i <br /> a <br /> e <br /> N <br /> O <br /> N <br /> o Rr0 <br /> ck r <br /> 7 21 IM <br /> 'm• °� <br /> °8 <br /> >) fn�V)ro ac A <br /> ani <br /> a < mC m 0� 3 <br /> N N O 7 0 <br /> i 1° <br /> I we declare that this application(including an accompanyingschedule has been examined b me us and to the best of , 0 <br /> ( ) PP ( 9 Y ) Y ( ) ��o: <br /> my(our)knowledge and belief it is true,correct and complete. I(we)acknowledge that I(we)am(are) responsible for the m m <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we) I 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 /> SIGN HERE <br /> (sign of owner or b 'ldin contractor) (date) <br /> o: o <br /> ZONING ADMINISTRATOR / � ' r �° '? ` o ' fn-n <br /> TOWNSHIP PERMITS MAY BE REQUIRED 8888ggevmi <br />