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BurPett Cqunty Office of Zoning Administrator ; 0 f o <br /> APPLICATION FOR - LAND USE - PERMITS m 3. <br /> z 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m c <br /> C <br /> as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 3 n <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- <br /> do sof the State of Wisconsin. � <br /> �h s M Gael Nn c7( n w m <br /> r �Lr ZP_fa1�_ I S <br /> m <br /> OWNER(Please rin}}) Con actor or S rveyo Agent <br /> A estt,Z <br /> i n 11 , , fn fd - i_LY`7 -� S �Y"P-T In/-r (aA W3 <br /> City,St te,,Zip Code City,State,Zip Coe 1 1 <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> 7 <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit <br /> Privy o <br /> N <br /> Structure Use: <br /> (family homelcabin, garage, addition,etc.) Z (� <br /> Oo <br /> a <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. rT <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 /> 0 <br /> 0 <br /> ar <br /> Z <br /> 0 <br /> A- Cached <br /> a <br /> 0 <br /> � N <br /> m <br /> m 0 <br /> O 0 <br /> m � <br /> 174 i - <br /> m <br /> m <br /> Z <br /> 0 <br /> Z <br /> 0 v,� > > 0 n—.m <br /> m n nm ":n9 <br /> a Si pcwo='3 <br /> m: Zm 0 Mi0 <br /> L'. <br /> _ <br /> Z <br /> 2; m <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 ` ^E m <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we) r I O <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 <br /> County of Burnett relying on this information I(we)am(are)providing in this application. I(we)agree to permit county offi- E `N <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. ice' <br /> m < ' <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATORYO <br /> - <br /> u/J IJNON��N� <br /> 5APPP9 Nm <br /> TOWNSHIP PERMITS MAY BE REQUIRED a88asaa(a <br />