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Bumett County Office of Zoning Administrator g a E o <br /> APPLICATION FOR — LAND USE — PERMITS = o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m rw X <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 3 n 0 <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- - <br /> tions of the State of Winqnsin. , m <br /> ,��,r1((�tc �11��1� u1 �CSII0\ C O <br /> OWNER Please Prin Co tractor S eyor or Agent a O F <br /> Add7Ad�7s o CD <br /> �- <br /> City,State,Zip Code City,State,Zip Code <br /> ('J lf- <br /> Telephone Telephone <br /> Permit(s)Applied for. <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit <br /> Privy Subdivision S <br /> _ — <br /> w <br /> Structure Use: <br /> (family home/cabin, garage,addition,etc.) Z <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). ,� 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. o <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 /> 3 <br /> o <br /> � .` O <br /> • - Vl � L y <br /> CA <br /> VC <br /> /n n <br /> N i <br /> \i on f- <br /> 2 <br /> o s <br /> j I)jj <br /> -n I�1j <br /> Z <br /> 0 <br /> Z <br /> 9 (a-0rn r D D my <br /> Z rn: two Zm3 <br /> o : , i -1 <br /> p = ; . <br /> N' in <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 '• m <br /> m <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we) '• ' ; ?� 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- �.C; '• , ,� , <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the i i : ?a 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- f pE <br /> mises at any reasonable time for the purpose of inspection. m <br /> m <br /> SIGN HERE <br /> (sure of owner orb 'ding contractor) (date) <br /> ZONING ADMINISTRATOR ( 1Y?f1!� E E '• <br /> N N 0iJ:+�NT <br /> tT tTppggNm <br /> OWNSHIP PERMITS MAY BE REQUIRED �8888a88rmii <br />