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Burnett County Office of Zoning Administrator ; o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work describec and v rn <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 r gula- <br /> tions of the State of Wisconsin. m m <br /> R08CRT (3PAuT MCRA '5' d VTTNA C Petr <br /> OWNER(Please Print) Contractor Surveyor or Agent n f <br /> H 17 t7vRSrT Z 80,K 13 d <br /> Address Address '^ <br /> PROSPECT HILLS T LL 60070F R WIS. 51 93 <br /> City,State,Zip Code City,State,Zip Code <br /> 31`2. - 259 -- 2097 <br /> Telephone Telephone J <br /> Permit(s)Applied for: <br /> New Building X— Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit <br /> Privy Subdivision <br /> m <br /> Structure Use: ° <br /> (family home/cabin, garage, addition,etc.) z <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). 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 ake, J <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 date d by <br /> the owner. <br /> O <br /> 3 <br /> 3 � <br /> D O <br /> Z <br /> O <br /> W N <br /> C <br /> n <br /> C� w <br /> N <br /> CA <br /> m n <br /> O o <br /> w <br /> 700 <br /> T <br /> N <br /> Z <br /> O <br /> Z <br /> IIIc_ <br /> I <br /> a mvmr DDtPy <br /> 0 v .> > n n= m <br /> aaM <br /> pN: n : 1 0 <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best o ,moo? E m : ? S <br /> my(our)knowledge and belief it is true,correct and complete. I (we)acknowledge that I (we)am (are) responsible for IN m <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we 'n,. p <br /> further declare that I(we)recognize that this information I(we)am(are)providing will be relied upon by the County of Bur U E <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 "w'-�'"� 2�P 1988 S v� <br /> (signature ner or buil ontractor) (date) rP' ` 8 <br /> l O S <br /> ZONING ADMINISTRATOR , <br /> ppppp+Nm <br /> (T UtOON <br /> NSHIP PERMITS MAYBE BE REQUIRED 8888888 U) <br />