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Burnett County Office of Zoning Administrator IWO f o <br /> APPLICATION FOR — LAND USE — PERMITS 3, <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and y 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 /> tionhe State of Wisconsin m m <br /> OWER(Please Print) Contractor or Surveyor or Agent n <br /> Addre Address <br /> �rw ,��.✓ S7//� <br /> City,State,Zip Code City,State,Zip Code <br /> /`G/2 -- 4/f 7 �3y1 <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit <br /> Privy Subdivision a <br /> Structure Use: ��./s:Po-./ �p2c �f��/�/��O�"'i �, !'62c/� �"�i�c' o <br /> (family home/cabin, garage, addition, etc.f z o <br /> o v J <br /> m <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. <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 /> a <br /> rVfz 4 3 <br /> 3 <br /> 1 <br /> Uj g <br /> IN <br /> I <br /> fju 7-1 <br /> m <br /> m <br /> —' <br /> v o <br /> V �y"- ADDi��•� Sl <br /> o <br /> � z <br /> -)49 � � vmrGamy <br /> o <br /> co ' 1 <br /> € M <br /> m <br /> o i n <br /> A <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 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 <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 reasons a time for the purpose of inspection. - <br /> m ! <br /> SIGN HERE - I I N <br /> '7i'_n+4 w <br /> of oner or ' g contractor) (date) 'moo: o <br /> ZONING ADMINISTRATOR m <br /> N N O N <br /> N n TNOO <br /> m <br /> TOWNSHIP PERMITS MAY BE REQUIRED 00008 fA <br />