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Burnett County Office of Zoning Administrator W0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d O <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m t` <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- <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. II - I , o <br /> �ul I <br /> 06 f(y A 1y E, �- I 111�C'� <br /> a 0 <br /> OWNER(Please Print) - j�ontra t r S Neyor or Agent <br /> fi <br /> 9213 Dalehurst Rd. 0gvn4-TAz- -iR 1�(��P(�IC , <br /> m <br /> Address Address t <br /> Santee Ca. 92071 (� <br /> City,State,Zip Code City,State,Zip Code S <br /> � <br /> 1 V 1 <br /> Telephone Telephone <br /> Permit(s)Applied for: 1 <br /> New Building Filling/Grading <br /> Addition —x— Moving o <br /> Sanitary Camping Unit n o <br /> Privy Subdivision 0 <br /> r <br /> 0 <br /> Structure Use: 12 x 24 addition 0 <br /> (family hometcabin, garage, addition, etc.) o 0 <br /> a <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, <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 /> 6. Provide Iegai description on the side at is orm as on tax stateffFent. <br /> 3 <br /> PLOT PLAN <br /> a N <br /> c <br /> Z Q <br /> O ¢ <br /> I y <br /> O <br /> 0 <br /> 1 <br /> T � <br /> I I <br /> 9 <br /> a 1 <br /> rYad� <br /> �7s' <br /> +� z <br /> wp -- -- o ---- > , o <br /> 1.r<ke a�' E8 J HT a5 3 <br /> 40, <br /> F-- b -�,r <br /> e <br /> I i �- yemnred <br /> a'I N8 I p <br /> I- - - -� ff tre J <br /> N o <br /> z <br /> HSS g 11 J '° <br /> _ � wvrnr ami <br /> m <br /> AC y. o <br /> Z O': 1 <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all m <br /> information contained in this application(including an accompanyingschedule and I further declare that I recognize that n O <br /> PP C 9 Y ) 9 <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 n <br /> in this applica ' I agree to permit county officials charged with administering county ordinances or other authorized <br /> person to hav ac ss to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE � A 7E � � I <br /> (signal a of owner or buildi ntractor) / (date) <br /> ZONING ADMINISTRATOR i o <br /> o: o <br /> N NOIJ���� <br /> OWNSHIP PERMITS MAY BE REQUIRED P N. O mma <br /> 0000 is <br />