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�- <br /> Burnett County Office of Zoning Administrator C m f o <br /> `APPLICATION FOR — LAND USE — PERMITS 3_ ' <br /> d o <br /> z <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and -U � � <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 Wisconsin. <br /> GO♦2DON HANSON A.M.EARTH'aSORKS CONST. INC <br /> OWNER(Please Print) Contractor or Surveyor or Agent ii f <br /> 2700 SO. BROADtIIAY P. O.BOX 71 m <br /> Address Address <br /> MENOMONIE, [VI 54.751 SPOONER, -11 54.801 <br /> City,State,Zip Code City,State Zi Code <br /> 713 ?35-7595 <br /> Telephone Telephone i, ', (� <br /> Permit(s)Applied for: Y7 <br /> New Building FillinglGrading -� <br /> Addition Moving o <br /> Sanitary X Camping Unit _ <br /> Privy Subdivision o <br /> 1a rple 9 Ln h l 5 <br /> Structure Use: � � ° 1 <br /> family homeicabin,garage,addition,etc.) Z <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. o <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 /> �f SEE ATTACHED SHEET o rryy// Z <br /> �h S�"Te 10�/7��d Ol6 �GGvt ru»¢i wnYet��dn 7� <br /> J k�s0 Al trot,if l" FjU ((Ay7As �� <br /> rn <br /> �� <br /> J <br /> i ) a <br /> c" LO <br /> 01 <br /> ,4 L5- A (So F/107" Y 7 A l N <br /> _) <br /> Cn <br /> 1"YtJr,1 — <br /> ((C' hip, "''fa. ler 3.o�I7 77, o <br /> 00 <br /> l � <br /> O Z <br /> 9 <br /> D Ca =0 0, m <br /> Q<= m =`. <br /> m ac <br /> =am =ELM <br /> m' � mo �m3 <br /> Z o: <br /> c' E m <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 i 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 reasonable time for the purpose of inspection. -n <br /> SIGN HERE �� 10-18-88 <br /> V: O <br /> �(si of owner q�buildin contractor) (date) E c <br /> ). <br /> o: o <br /> ZONING ADMINISTRATOR ��� ��o. �-n <br /> /TOWNSHIP PERMITS M / <br /> / BE REQUIRED o 000fn <br /> l <br />