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Burnett County Office of Zoning Administrator o o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> z s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and U m <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 3 n <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- <br /> tion( fJthof Wiscong�S ` 77 ) - <br /> m m <br /> V <br /> OWNER (Please Py�rint) Contractor or Surveyor or Agent n F <br /> Address Address <br /> sU s� <br /> .4,j , <br /> sops <br /> City,State,Zip Code �. City,State,Zip Code <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving <br /> Sanitary Camping Unit <br /> PrivySubdivision o <br /> o <br /> Structure Use: <br /> (family home/cabin, garage, addition, etc.) Z <br /> P ° <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). 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. N <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 /> 0 <br /> a N <br /> Z <br /> _. <br /> cn <br /> A <br /> 3o Ll <br /> o <br /> �' r I Z�r 3� _---cam•_ I� 1r z-�fi � � o— <br /> T <br /> O <br /> Z <br /> 71 <br /> �C'lic�C(illl� z = ' m o M,n' 3 <br /> CD [ M <br /> Tn: c m <br /> o ; [ A <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of �o <br /> my(our)knowledge and belief it is true,correct and complete. I (we)acknowledge that I (we)am(are) responsible for the <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and m <br /> I (we) :� m <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 a: <br /> County of Burnett relying on this information I(we)am(are)providing in this application. I(we)agree to permit county offi- ` a: <br /> cials charged with administering county ordinances or other authorized person to have access to the above described pre- i i i rn <br /> mises at any reasonable time Pr the purpos f ins n. m ' ;D: ' <br /> SIGN HERE !/ 1 <br /> (sigur of owner or b it ing contractor) (date) ' oe <br /> ZONING ADMINISTRATOR , ` ='I a yi-n <br /> �]� N N�+Nm <br /> 1 fT (T O O G� <br /> /T WNSHIP PERMITS MAY E REQUIRED 8 0008(m/� <br />