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01- ((°a_�' <br /> Burnett Courfty Office of Zoning Administrator ; m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> d o <br /> a <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and � 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 /> tions of the State of Wisconsin. o <br /> PETER ANDERSON MELVIN J. FERGUSON 0 <br /> OWNER(Please Print Contractor or Surveyor or Agent n F <br /> 280 KINGSWAY VIZ, HCR 59 BOX 478—D w <br /> Addreaa MANKATO, MN 56003 Address aN SPOONER, j"12 54801 <br /> City,State,Zip Code City State,Zip Code <br /> (715) 635-7482 ( I <br /> Telephone Telephone <br /> Permit(s)Applied for: S <br /> New Building Filling/Grading <br /> Addition Moving <br /> 0 <br /> Sanitary X Camping Unit <br /> Privy Subdivision o <br /> w <br /> Structure Use: 3 BR HOME g <br /> (family homelcabin, 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. o <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 /> 3 <br /> a p <br /> C�FFST) C. CtSTI Tp �eST Por n� K0. I .S M t P <br /> To urn I✓� Cu4i nue -6 ve.A,,'Y eVLJ- . <br /> N <br /> v <br /> n <br /> 5 <br /> N <br /> AS ATTACHED ° <br /> O <br /> N <br /> s m <br /> m ° <br /> 0 0 <br /> Ir <br /> IND <br /> N_ IJ <br /> i <br /> Z <br /> O <br /> M c-0 V) >nam-al 0 <br /> E <br /> � woUm' 3_ <br /> P o mQ '• <br /> N' <br /> N: Q <br /> n <br /> c( ! C <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of <br /> my(our) knowledge and belief it is true,correct and complete. I(we)acknowledge that I(we)am(are)responsible for the . i m <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- <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the 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 orother authorized person to have access to the above described pre- ; n <br /> mises at any reasonable time for"PT urpose of inspection. '• <br /> SIGN HERE �' 2-0 <br /> _oT e or building contractor) (date) E c ( E <br /> ZONING ADMINISTRATORlYl <br /> °I v,Inrnoornm <br /> TOWNSHIP PERMITS MAY BE REQUIRED $880000tmif <br />