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.79'7 C�f7v - <br /> Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> z � o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and v w <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 /> I//P — <br /> tiQq��s,pf the St a of Wiyys��onsin. / o <br /> I�KQ /1QIIV/} S�1�Nb Ury �� c <br /> n O <br /> O NE (Please Pri t Contractor or S y r o A ent F <br /> �l� o �. 1/azo ,,i " iL.,✓ a <br /> Address dress m � <br /> L(, nne fin � . m� Ad <br /> 3 /hi 67l 4L `AV n <br /> Cit State,Zi Code City, State,Zip Code <br /> N -�?,a- �')') G1Z Q31' S-67) <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading WW <br /> Addition g.VCWW_e X, Moving o <br /> Sanitary �(f6 fq Camping Unit m <br /> �f <br /> Privy Subdivision o <br /> 0 <br /> tisf�lL Wli, o�tl q-SC2ae�r & <br /> ox rl`�,sf/es tkc{c ( ►b /a4 a F 0 <br /> Structure use: o � <br /> (family home/cabin, garage, addition,etc.) z <br /> o ° <br /> a <br /> m O <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North (N). <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, <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 z <br /> the owner. <br /> t o <br /> Elfjstus p�'2s~�T Sz3 &' z�Ke,, a <br /> Z <br /> /i j o <br /> jQodl- UPtS'�--y 9't ��v�W� <br /> :ZZ, <br /> T�fS�l1C�' _7 <br /> LIaQPN•9 /�J 01e¢.i i�yj Q � ��,' <br /> nF st P(. <br /> C , <br /> (o i8v fj <br /> Recu+�2a"1e�t�� zc <br /> CLntZ I OZ <br /> Z <br /> D <br /> � fIII`N'11 <br /> I <br /> m c� oWrw >M-o <br /> o vcocon-.m <br /> m nuc - nm ';a70 <br /> .02 � <br /> Z10 <br /> 0 o <br /> Lwkt i,[ i 2 m <br /> o c C <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of b: ; , <br /> my(our) knowledge and belief it is true, correct and complete. I(we)acknowledge that I(we)am(are) responsible for the In <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we) . ^ 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- iF <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result 0 i i :o: <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- . 'N <br /> mises at any reasonable time for the p rpose of inspection. i i i p' <br /> m [ i iTi E <br /> SIGN HERE <br /> (sign a of owner or builpl v contract r) (date) <br /> ZONING ADMINISTRATOR 085 <br /> �mOWNSHIP PERMITS MAY BE UIRED o080CM"n <br />