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Burnett C6unty Office of Zoning Administrator ; 0 -.1 <br /> o <br /> APPLICATION FOR — LAND USE — PERMITS d 3- <br /> a s n <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and -0 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 /> tions of the State of Wiscoji$in. <br /> T/J0m.'� S fl ,/VVeur6 = m � � <br /> OWNER(Please Print) p _ Contractor or Surveyor or Agent °- F <br /> M v o <br /> Add�,rq s Address "✓ _ <br /> Alm <br /> Yl7Jc. C� N <br /> City,State,Zip Code City,State,Zip Code <br /> bid i73 ti 17�( <br /> Telephone Telephone <br /> Permit(s)Applied for: f <br /> New Building Filling/Grading <br /> Addition Moving O _ <br /> Sanitary Camping Unit <br /> Privy c Subdivision 0 D� <br /> Structure Use: nF <br /> (family home/cabin,garage,addition,etc.) o 0 <br /> a <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 /> O <br /> 0 <br /> 3 r­ <br /> 1P o <br /> Z <br /> o <br /> l� o <br /> C <br /> c <br /> a <br /> N <br /> O <br /> J <br /> O <br /> J N <br /> J N <br /> fp A <br /> O 0 <br /> N_ J <br /> 1 � <br /> ZN <br /> Z <br /> O <br /> Z <br /> M (n-0rnr DD M-0 <br /> 0 c -.mmoacm <br /> 0 a< J J o a= <br /> m nuc ao =am <br /> d N - <br /> Z 0` <br /> 0 0 'C -i <br /> _ vs A <br /> 2i <br /> 0 : <br /> 8 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 ^: m <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we) i i i ri C <br /> further declare that I(we)recognize that this information I(we)am(are)providing will be relied upon by the County of Bur- a <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the i i i <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. - ? rr <br /> m <br /> SIGN HERE m <br /> ature of o er or building contractor) (date) ; o <br /> 7 'I JI ?E o <br /> ZONING ADMINISTRATOR T <br /> J N N O N + m <br /> (T(T(T(T O <br /> TOWNSHIP PER S MAY BE REQUIRED 000S o MM <br /> TOWNSHIP <br />