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Burnett CountyOffice of Zoning Administrator ; 80 f o <br /> APPLICATION FOR — LAND USE — PERMITS d 3. <br /> a g <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and � m <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- _ <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applica le County Ordinances and the laws and regula- 3 <br /> tion of the S ate o Wis opsin. 1 � /I m o <br /> Vi �l f/ O 4vt -el' 50Q Coit S�vu�TtrO <br /> O R(Please/parent) —7—7 7 ,{' Contractor or Surveyor or Agent o. f <br /> Vrelg Addre< <br /> Citye,Zip Code 7 -t-o �j7 City,State,Zip Code <br /> vl �. <br /> Telephone Telephone,Stat <br /> Permit(s)Applied for: <br /> New Building Filling/Grading . <br /> r <br /> Addition Moving <br /> 0 <br /> Sanitary Camping Unit <br /> Privy Subdivision o <br /> Structure Use: <br /> x �{ 6 V-0( lie a <br /> (family hom cabin, garage, addition, etc.) Z <br /> o ° <br /> a / <br /> _ <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North(N). .71. 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. r <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 /> .Z <br /> � 0 <br /> It) <br /> ' <br /> U ✓c m m <br /> r Q <br /> 300 Je_e P ROA c J <br /> � Q N <br /> S = <br /> 20� v'� <br /> 80r � 00 w, d� <br /> co <br /> I i <br /> FA, o <br /> Fc� <br /> _ - - - <br /> 711 <br /> 7�, � <br /> m <br /> Z <br /> N <br /> M co Vlnr DD W y <br /> M c _-= moat <br /> 0 Q< 7 � ° d S.m <br /> /I //� / ^ � wp �ro3 <br /> ° � ; <br /> 01 <br /> se <br /> 2€ im <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of S <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) <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 :C <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 ordinancep or other authorized person to have access to the above described pre- <br /> mises at any reaso time or thf purpoV of i spection. <br /> :rt <br /> SIGN HERE <br /> (si u e of owner or bui contractor) (date) : o o <br /> ZONING ADMINISTRATOR rtl <br /> `nyUrooi���roRl <br /> W ti•tTN00(T <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o S o 0 0 o tmn <br />