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Burnett County Office of Zoning Administrator d 0 0 <br /> APPLICATION FOR - LAND USE - PERMITS . <br /> d O <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and " N <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m T <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 Wisconsin. <br /> N d � <br /> Merlyn T. Maroney `" m O <br /> a f <br /> OWNER(Please Print) Contractor or Surveyor or Agent r- <br /> 9213 <br /> 9213 Dalehurst Rd. m <br /> m m <br /> Address Address <br /> Santee, Ca. 92071 a <br /> City,State,Zip Code City,State,Zip Code Iws <br /> (619) 562-5083 ~ <br /> Telephone Telephone (� <br /> H <br /> Permit(s)Applied for: <br /> l 3 <br /> New Building Filling/Grading w <br /> n <br /> Addition Moving o 0 <br /> Sanitary Camping Unit ro <br /> 0 <br /> Privy Subdivision 0 lc- <br /> �' r <br /> Structure Use: <br /> (family ho a/cabin, garage, addition, etc.) 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(NS)and indicate North(N). <br /> 2. Show the location of the well (W) septic tank(ST),and drainfield (DF). « -3 <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. J,} 0 <br /> w <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, _- o• <br /> river or stream, if applicable. m <br /> 5. If,separate plans are submitted by an architect,engineer, builder,contractor,etc.,the plans must be signed and dated by w <br /> the owner. <br /> x <br /> ProvTde legal on a side o is form) as on ax statement. <br /> o m <br /> PLOT PLAN description3 I rn <br /> r <br /> Z N a <br /> G y <br /> SEE ATTACHED a <br /> 7 0 <br /> a <br /> LI rn <br /> ! I <br /> - a <br /> m <br /> o <br /> m 0 <br /> 0 N <br /> O .3 <br /> N. <br /> r0 � <br /> O <T <br /> 1 <br /> T <br /> Z <br /> J o <br /> r trJ <br /> � Z <br /> I � � <br /> 'S W <br /> r• <br /> CL <br /> m <br /> D Q DDDR <br /> SD Q. mani <br /> v m yoo ; <br /> O J p <br /> 0 <br /> m <br /> (77' E[ c: C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my —o: m : X <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that ' p <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a <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 a <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE�' � 0 / d' <br /> grature of own or buil ing contractor) (date) <br /> ZONING ADMINISTRATOR — 7f1(/:p ! _ 7, n.Q2a <br /> J <br /> fn T <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> `moo 000fmA <br />