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Burnett C6wnty Office of Zoning Administrator ow W f o <br /> APPLICATION FOR — LAND USE — PERMITS 3. ' <br /> z <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and v 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 /> tions of the State of Wisconsin. o \l <br /> w m <br /> m <br /> OWNER Please riot) Contractor or Surveyor or Agent <br /> o ° <br /> Address Address <br /> Fieder�'c J,c/z �37 P — <br /> City,S�ate,Zip Code City,State,Zip Code Ln <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building FillinglGrading _ <br /> Addition T Moving o <br /> Sanitary ✓ Camping Unit <br /> Privy Subdivision <br /> 2.611i2aZ 01244 w � <br /> Structure Use: ° <br /> (family ho a/cabin, garage, addition, etc.) z o <br /> 0 0 <br /> m <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NS)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, i` <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 /> 3 r <br /> 0 0 <br /> Z <br /> O <br /> U. <br /> c <br /> � a <br /> 0 � <br /> O G co <br /> m v\ n <br /> O 0 <br /> m ! � <br /> � R <br /> J Z <br /> G- o <br /> z <br /> 0 n <br /> m c�wioonc�m <br /> 0 a< > > 0a <br /> m a< am =am <br /> N `ZWoo Om <br /> m <br /> ns O <br /> 's c <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of 8 m : <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) i 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 -� o <br /> (si atu of owner or it g contractor) (date) <br /> o: o <br /> ZONING ADMINISTRATOR <br /> OI(TNN OOfT <br /> TOWNSHIP PERMITS MAY BE REQUIRED o000008rmA <br />