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... ., <br /> ON COMPUTER/SCANNED (2`7- <br /> . Burrett County Office of Zoning Administrator a) 0 0 <br /> 4 APPLICATION FOR — LAND USE — PERMITS �. o y <br /> . U <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and rn c ._-> <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 3 0 <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- — ✓� <br /> tion of the State of Wisconsin. N Flt/a <br /> (, Eu/4? <br /> Ao4»er7 c 11110 <br /> 0 <br /> OWNER(Please Print) Contractor or Surveyor or Agent a (--"C, <br /> £' 8 "Oa' SVC a <br /> Address Address •m <br /> Fs <br /> City,State, ip Code City,State,Zip Code <br /> (7/ ) P6?6,- 71v-20 <br /> Telephone Telephone � <br /> ' <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary ✓ Camping Unit ii3 F. <br /> Privy Subdivision o D.--- <br /> y <br /> Structure Use: ° <br /> (family home/cabin, garage, addition,etc.) z o <br /> o -o <br /> m lb1. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North (N). .e 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 °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. s <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 /> t <br /> 0 <br /> 0 <br /> 3 r- <br /> o <br /> z <br /> \lo <br /> fCc):) _,..... <br /> 8 C <br /> c <br /> cr <br /> d i a <br /> A <br /> Sk' <br /> 4 (.1.)c/1-. ...,))Clay ° <br /> CDC) <br /> z <br /> 0 <br /> z <br /> 53 <br /> 70 CI) cnr>>W13 <br /> co. o.•< -•aCD r;a7o <br /> •< to07an <br /> o `° <br /> z • .Z =1 <br /> o , ct) MI <br /> 2 m <br /> 6 n 0 <br /> o 2. C <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of o m - <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) G <br /> further declare that I(we)recognize that this information I(we)am(are)providing will be relied upon by the County of Bur- �y <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the e� <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. m <br /> CD <br /> 69 <br /> SIGN HERE r h--k-)-4- CP <br /> (si••- e/ooff o7wne it/diinngcontractor) (date) 0 0 <br /> ZONING ADMINISTRATOR / r) <br /> N N O N 1 CD N m <br /> (T CA(T CT700Cn <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 o 0 o vi <br />