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Burnett County Office of Zoning Administrator m f c <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and -u w <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 3 ma 1 <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- o J <br /> Igs of the State of Wisconsin. w 1� INI <br /> /Bruce �l feuuv �rman _ race- .�I,�Gi DvnaS \v� <br /> OWNER Please Pri9t) Co tractor or S rveyor or A nt n F <br /> 5w5 t- /Lac /5� -re/e,i- I� a o�C Fs'7 <br /> Addrf3sJh `ake5 r' I ft 5-5o Ad e�ss m \ <br /> LL o '4 - rey► WI: 5_ a. <br /> City,State,Zip Code City,State,Zip C9de <br /> (o ft— '78`�'c09O`7 SIS-349-5571 <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading 1pU <br /> Addition Moving <br /> 0 <br /> Sanitary Camping Unit <br /> Privy Subdivision o O <br /> w <br /> Structure Use: Q.YYLIJ 0 3 <br /> (family home/cabin, garage, addition,etc.) z R <br /> o ° <br /> v <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. r <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 /> fo <br /> O <br /> —Cen-i-en- �n'� 9 0 <br /> z <br /> P p. <br /> (A T7 <br /> IP- <br /> J Itr VJ Of N <br /> n P <br /> m w. <br /> o <br /> 6r r <br /> No <br /> m � n <br /> O p <br /> 391 361 ` <br /> 00 <br /> m <br /> 0RsIS � <br /> ro I� <br /> M lA T rn�D D a,-0 <br /> loZ7 0 `o--'w = 8a`-'m <br /> R o'� '0 LR R.M <br /> <.E °i C w o 3 <br /> J Z w : Z N p =m <br /> N: C m <br /> »: <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of <br /> o : m : <br /> my(our)knowledge and belief it is true,correct and complete. I (we)acknowledge that I (we)am(are) responsible for the pQ^E <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we) m <br /> further declare that I(we)recognize that this information I(we) are ®� <br /> ( )am(are) 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 EoE : <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. T p i t <br /> m <br /> SIGN HERE <br /> is' <br /> atu a of owner u' ing contractor) <br /> (date) 1 o E E o <br /> ZONING ADMINISTRATOR <br /> (T(TN(TO N <br /> TOWNSHIP PERMITS MAY BE REQUIRED S S S S S o S <br /> 1 <br />