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Burnett County Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS F <br /> d = <br /> z o ko TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and u 00 <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- n <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable ounty Ordinances and the laws and regula. <br /> tionggf theStatg,of WiWcosinOW R leasePrint) Contra r Su eyor or Agent a <br /> Add a Addres m <br /> �'��',�'Tse /I7D , ,,_ i3 <br /> City,State,Zip add —'�• City,State,Zip Code <br /> �j C�l� , m <br /> Telephone g�� — ��j�_OtT^ Telephone <br /> Permit(s)Applied for: <br /> 'j <br /> A\ <br /> New Building Filling/Grading `A <br /> Addition _�_ Moving o y <br /> Sanitary Camping Unit m <br /> Privy Subdivision \ <br /> o iStructure Use: • 0 <br /> (family tfomelcabin, garage,addition,etc.) Z v <br /> o ° <br /> a <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North(N). <br /> 2. Show the location of the well(W),septic tank(ST),and drainfield(DF). 0 o <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 /> O <br /> a o <br /> Z <br /> 0 <br /> W — m <br /> c <br /> 1 n <br /> 3 <br /> 0 <br /> I = <br /> \ 86I y <br /> d _ O <br /> • <br /> i <br /> Z <br /> O G <br /> a <br /> ,SAP.7) <br /> � ulVNr DDWy <br /> � c '> joncm <br /> m n� nm aay <br /> Ke <br /> o ff0 3 <br /> c0: M <br /> m <br /> Cc jo <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of <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) i.: 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 a <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- i F <br /> mises at any reasonable time for the purpose spection. m E i i '. a : <br /> SIGN HERE <br /> isi re of owner orb Idin c tractor (date) �' ' o <br /> ZONING ADMINISTRATOR <br /> N N O N m <br /> (T V•N Vt O <br /> OWNSHIP PERMITS MAY REQUIRED oo�o o N <br />