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Office of Zoning Administrator C o c <br /> Burnett County 2. 3 <br /> APPLICATION FOR — LAND USE — PERMITS o s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and w <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- 301 <br /> C, <br /> tions of the State of Wisconsin. _ O <br /> t"d`ti' � /�Lc(, ✓f f L 0 is ,� • W i ��/iYrri3 a J � O <br /> _ f <br /> OWNER(Please Print)n Contractor or Surveyor or Agent p J <br /> J-y ryQ.�P K �l Ew � m <br /> Address Address l <br /> S7 ��wL /77'✓ 3'�//� c <br /> � <br /> City,State,Zp Code City,State,Zip Code U <br /> 2 <br /> Telephone <br /> Telephone CY <br /> Permit(s)Applied for. C <br /> New Building FillinglGrading P. <br /> Addition — Moving g <br /> Sanitary Camping Unit .��. o <br /> 0 <br /> Privy Subdivision m <br /> / o <br /> Structure Use: `� � ''�' 1�A �/ iw, f2od.• a Z v <br /> (family homelcabin, garage,additio ,etc.) o o° <br /> m <br /> Directions for plot plan drawing: ` <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). <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. \. <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, .7 <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.6. N <br /> rove a eqa Iegc; is ion on a si a e o is orm as on tax statement. 0 <br /> PLOT PLAN -9 <br /> -9 u+ <br /> /' Z Q <br /> y <br /> Lot �; . f I �� <br /> � _. SEC sd'i,'� ^ •' <br /> �� 0 M h <br /> L� f� i to U o <br /> ST r ( m <br /> !/ r <br /> Ye <br /> Ad Sr �L bG <br /> �► 'Z q -- - ?i ti cc <br /> 0. <br /> art at7f a 1 �C) <br /> Z <br /> 0 <br /> n Z <br /> my nrm <br /> I .7> m nom ''– a c <br /> i Z N <br /> N: A <br /> L/3/fe /�r�,A lv� frk /rangy/ L /�1�� U �Ir. P�wrl :A€ i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all a n m <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a oo <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing a <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m <br /> m , <br /> SIGN HERE da e) <br /> re of owner or u' ing contractor) ( o $ <br /> o: o <br /> o: <br /> ZONING ADMINISTRATOR GG I <br /> f C <br /> NNOiJ� N <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N p O O N <br /> 00000 0 <br /> 0000000 <br />