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Burnett County Office of Zoning Administrator ; '0 f a <br /> APPLICATION FOR - LAND USE - PERMITS 3 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m m C'> <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 3 a <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 <br /> m 0) <br /> C <br /> m Q <br /> OWNER(Please Print) Contractor or Surveyor or Agent o. Q- £ <br /> Kenneth G. & Maril n H. Washenberger Owner ° fl) <br /> Address llc)y ,• (?, Address m y <br /> St. Paul. MN 55104 X <br /> fD <br /> City,State,Zip Code City,State,Zip Code 1 7 <br /> 612-644-1065 r� <br /> Telephone Telephone <br /> S <br /> Permit(s)Applied for: n <br /> New Building X Filling/Grading m <br /> Addition Moving o <br /> d <br /> Sanitary Camping Unit z <br /> Privy Subdivision o <br /> 0 7 <br /> N <br /> Structure Use: Storage o = <br /> (family home/cabin, garage,addition,etc.) Z 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" r M <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, 3 0 <br /> river or stream, if applicable. — z <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and dated by to <br /> the owner. ul (D <br /> 0 Z <br /> 0 <br /> 3 p <br /> Z 1 <br /> 11M <br /> #1 - no existing buildings 0. <br /> #2 - no well, septic tank or drainfield on property I fl) <br /> #3, 4 & 5 - see attachment Q <br /> n <br /> ti <br /> - o <br /> V� <br /> 0 r� <br /> N <br /> m <br /> m n <br /> O p <br /> 0 <br /> 9 <br /> 4, r L <br /> m cM.NN asam <br /> n m <br /> m a nm �nA <br /> a < <br /> '0 Mo <br /> O O ' i U I <br /> 7nE € c E m <br /> � c� n : E IS <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of m <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 1 (we) <br /> further declare that I(we)recognize that this information I(we)am(are)providing will be relied upon by the County of Bur. ;p <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the /n� I 3=: <br /> County of Burnett relying on this information I(we)am(are)providing in this application.I(we)agree to permit county offi- <br /> a: <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. <br /> r <br /> SIGN HERE 10/5/88 <br /> ' tJi <br /> ntractor) (date) <br /> ZONING ADMINISTRA R ,»T <br /> .uNi�Nrno m <br /> TOWNSHIP PERMITS MAY BE REQUIRED 000S SfA <br />