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Burnett County Office of Zoning Administrator '0 0 <br /> APPLICATION FOR — LAND USE — PERMITS iv ' <br /> s <br /> 70 THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <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 applicable County Ordinances and the laws and regula- 3 <br /> tions of the State of Wisconsin. m p <br /> I-Ioyd D. 5rie <br /> OWNEROlease Print u( Qx .2-10 Contractor or Surveyor or Agent O <br /> R R Io F <br /> 17 ' <br /> Address <br /> 7' 91 <br /> Webster Wl 64M Address m <br /> r <br /> C�ty,state,Zip Code � n` City,State,Zip Code O <br /> C LYJ <br /> Telephone <br /> Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving <br /> Sanitary <br /> Camping Unit � <br /> n <br /> Privy __// JJ Subdivision o V ' <br /> Structure Use: d d d r+;nn St0 ragta AQCP o <br /> (family hometcabin, garage,addition,etc.) Z <br /> o <br /> v <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. 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 /> 7 /'O' 7v t4w� l r,f 11Fe !�l �S 3 <br /> Ll n� /t 7'5 - r� <br /> F <br /> <— .24 FEET--� f� o <br /> Bedroom <br /> a <br /> ROOM <br /> lu <br /> LiVt �� t y <br /> 0 <br /> 3Cn <br /> i17L ffA $ai hYmm iG 0 0 <br /> pedrom <br /> eZ <br /> 71 FE6T To Center k,tdtlith p <br /> of rhe Rodd J Z <br /> 0 <br /> % Z <br />>-O well New . �► <br /> a-T� Addition <br /> K R 00 Ram <br /> (� d0 n_ M <br /> O N : `ZN O 5'3"M <br /> Z O i m <br /> P O <br /> �' <br /> my(our)knowledge and belief it is true,correct and complete. I (we)acknowledge that I (we)am(are) responsible for the ' <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we) �� p <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 ' ?Q <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- ' irn' i <br /> mises at any reasonable time for the purpose of inspection. -n E <br /> Epi <br /> SIGN HERE <br /> (si at a of owner or it contractor) ate <br /> ( ) <br /> ZONING ADMINISTRATOR <br /> HINT(OTN O m <br /> TOWNSHIP PERMIT AY BE REQUIRED oogo tm/1 <br />