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Burnett County Office of Zoning Administrator ; m f o <br /> APPLICATION FOR — LAND USE — PERMITS d 3' <br /> z o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m ow <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- n <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- <br /> tions th State of Wisconsin. w m <br /> OWNE (Please Pri t) Contractor or Surveyor Agent <br /> o. f <br /> R� �Tu ��g�� �_ <br /> Addr�e.�gyYL,,11�-�,1• / Address m I <br /> City,State,Zip Code—f City,State,Zip Code <br /> I <br /> Telephone Telephone <br /> Permits)Applied for: V <br /> New Building Filling/Grading <br /> Addition Moving v <br /> Sanitary Camping Unit <br /> Privy Subdivision o <br /> w <br /> Structure Use: ° <br /> (family home/cabin,garage,addition,etc.) Z o <br /> 0 <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 /> 0 <br /> 0 <br /> n a pt <br /> T Z <br /> � / � chedCSf o <br /> _/1T/LC�`f <br /> L <br /> W W to <br /> �q L <br /> t <br /> I ages , o <br /> J <br /> P o <br /> e J <br /> o� <br /> m <br /> /_ ^ <br /> T /T �v- -Y�owev" �Ou^U2r.. <br /> �us��'e.^ a✓eu sew <br /> sic L ���^- <br /> Ccs ea selnal{ re�a✓�s l ?'/d��� ?eta <br /> Y ' [OMS <br /> Se/( t//3 Pio�d'A r/ <br /> G/j,n I 00 ca 0. 0. DDWy <br /> c<'> > mn nc <br /> a E.m <br /> m <br /> ac =am ';n <br /> o m'E ? Co �m' 3 <br /> y: A <br /> sm <br /> a: 0 : O <br /> o i c C <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of o_ <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- E EoE <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the ` i& <br /> County of Burnett relying on this information I(we)am(are)providing in this application.I(we)agree to permit county offi- i [ [w <br /> cials charged with administering county ordinances or other authorized person to have access to the above described pre- ` 'O <br /> mises at any reasonable time for the purpose of inspection. <br /> Ir 5 <br /> SIGN HERE <br /> is re of owner or b ing cctractor) (date) <br /> ZONING ADMINISTRATOR NN O IV n'i m <br /> P,OP fT 00 fl, <br /> 000c000m <br /> OWNSHIP PERMITS MAY REQUIRED o 0 0 0 0 0 o fA <br />