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Burnett CountyON COMPUTER/SCANNED 0Z <br /> , Office of Zoning Administrato0 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS _ 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and v CO o f� <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- -, m <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula-..3 <br /> • a " <br /> tions of the State of Wisconsin. o <br /> c <br /> m <br /> 111 <br /> OWNER(Please Print) Contractor or S S 'TIO <br /> r CAVATION hi & K co <br /> Ket TN YY1 of�'TF n SEX) v <br /> Er: <br /> Address Address + m <br /> 1 to 15 3rd Ave 6'0 Spocner, WI 54801 rn X <br /> City,State,Zip Code City,State,Zip Code(71b)635=/482 7S <br /> �,e ui `bc‘ htr aMr) 55 112_ Zi, ( <br /> ) <br /> Telephone Telephone �o\ ),) Z <br /> Permit(s)Applied for: , ( <br /> New Building Filling/Grading _) <br /> Addition Moving '� <br /> Moving .0 v O <br /> Sanitary Camping Unit 0 <br /> Privy Subdivision JA _ g <br /> N <br /> Structure Use: o <br /> (family home/cabin,garage,addition,etc.) Z a <br /> P -o <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North(N). h1 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. �-�\ i- <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, . .2 ° <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 `i <br /> the owner. �,1 <br /> n <br /> 0 <br /> 3 V r <br /> 0 <br /> z <br /> 0 <br /> A-� ATf � m <br /> a. <br /> L rM ` l <br /> 90 N , <br /> O i� <br /> o ` o <br /> 1471 11 i ,-,.., am▪ (---1, <br /> T1 t(D <br /> Z <br /> O <br /> Z <br /> sl <br /> J <br /> oe <br /> 6-- <br /> o <br /> 70 Ci)-00r>>Co. <br /> OC < Ca CfnC7 j ma , <br /> CD Ca,s< -•aa23 <br /> Zto ' 0 0 o ca <br /> O O Cr'`z <br /> Cn33 <br /> t C77 C <br /> �'�O 0 <br /> C 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 77 <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) C <br /> further declare that I(we)recognize that this information I(we)am(are)providing will be relied upon by the County of Bur- (J' r` <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the Ep <br /> County of Burnett relying on this information I(we)am(are)providing in this application. I(we)agree to permit county offi- o <br /> vials charged with administering county ordinances or other authorized person to have access to the above described pre- l:2' <br /> mises at any reasonable time for the purpose of inspection. m in <br /> -13 <br /> SIGN HERE Tr§, C tE p V . <br /> J <br /> 3 69 <br /> of owner or bui •' o <br /> (signature g ontrrac ar) r�._ (date) r'� J i o <br /> ZONING ADMINISTRATOR ''`' 0 - 7 B <br /> 0Y, � <br /> oom <br /> TOWNSHIP •E'' ITS MAY BE REQUIRED __ .l o 0 0 6 f/1 <br />