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Burnett Com` Of ce o Zoning Administrator o <br /> APPLICATION FOR — L(NDUSE — ER ITS �TO THE ZONING ADMINISTRATOR: The undersigned herebypplication forPermi he work described and v m <br /> located as shown herein.The undersigned agrees that alf work00 <br /> sone in accords a with a requirements of the Bur- mmnett County Land Use Ordinance,Sanitation Code,and with all licable County rdin laws and regula- 3 a <br /> tion of the State of Wisconsin. n w <br /> Thr/�nl 5 7-i57/j Gr uowL <br /> OWNER(Please Print) Con to or Surveyor or Agent a F <br /> 'R� Y X50 Gcl zu/ IC.g57— <br /> Z <br /> Address Address <br /> S T J/,'fArUL m 1-^wx53oi - 7 o i+ r' <br /> City,Statp,Zip Cod City,State,Zip Code W 6 <br /> 2 - 7-yo ,3 7.43 <br /> Telephone Telephone m <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving CZo <br /> Sanitary Camping Unit <br /> Privy Subdivision o <br /> = n^ <br /> Structure Use: <br /> r7Z) <br /> N wl <br /> (family home/cabin,garage, addition,etc.) o <br /> CD0 <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, N 6) <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 r T <br /> the owner. L I <br /> v o <br /> �" Z <br /> Cr <br /> c <br /> _n <br /> ' A <br /> C <br /> b y <br /> 0 <br /> r 6 <br /> o p <br /> e-4 <br /> m <br /> 0 0 <br /> w s z <br /> o <br /> � n Z <br /> M cnvv, DDaoV <br /> �., Q= � �00g=_.m <br /> m c,� CLm �;a7D <br /> N ? N p =t0 <br /> P O 1 <br /> JE✓�. Il f ((� PP,rrn; 3 13 R i m <br /> : D <br /> 8€ E-; c <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of 0 I <br /> my(our) knowledge and belief it is true,correct and complete. I (we)acknowledge that I(we)am(are) responsible for the 00.Fz !n: m <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we) ip <br /> further declare that I(we)recognize that this information I(we)am(are)providing will be relied upon by the County of Bur- 'o <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the i0i <br /> County of Burnett relying on this information I(we)am(are)providing in this application.I(we)agree to permit county offi- ; i <br /> cials charged with administering county ordinances or other author person to have access to the above described pre- :0. <br /> mises at any reasonable time for the purpose of inspection. m <br /> SIGN HERE d' <br /> (si a r of owne ilding co tractor) (date) <br /> O S: <br /> 40MINISTRATOR yi <br /> m N O ro L J N <br /> Vf V1 O+V1 O V7 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 88088 <br />