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Burnett County Office of Zoning Administrator C0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 2. 3. <br /> d o <br /> TO TH9 ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 6T <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m c <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 a <br /> tions of the State of Wisconsin. " o q <br /> u, m <br /> 6Id As I <br /> o <br /> r.ER'Please Priri _ Contractor or Surveyor or Agent n 'T <br /> Vm <br /> Andress,/ ./ � /_ L� z� , // Address DQ <br /> �L Orr (L 7 <br /> City, State,Zip Code City,State,Zip Code <br /> Telephone Telephone (C �-- <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary — Camping Unit n o Z <br /> Privy Subdivision 0 <br /> �,� <br /> 1 m r <br /> Ill�R-q W 0 0 <br /> Structure Use: CA <br /> v <br /> (f mily home/cabin, garage, addition,etc.) o c° <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. -e7 O r <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. Q <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. o y <br /> PLOT PLAN B <br /> c <br /> Z -� o <br /> O a <br /> rt• `- IIIIIIIr'Sy- <br /> y I <br /> v) a <br /> r � s <br /> � 0 <br /> 0 <br /> N <br /> O <br /> 0 <br /> O _ <br /> `^ UJ <br /> T (JC\ <br /> N Y <br /> Z <br /> O <br /> Z <br /> I D <br /> ]0 W_ rDDOoM <br /> n a< � n n <br /> MM <br /> LD. n� m � <br /> o <_' w0� 3 <br /> v oDo <br /> 0 0: 2 <br /> c ; m c : p <br /> o c C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 0M <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 any accompanying schedule)and I further declare that I recognize that a p <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a o <br /> o : <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing w <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized n <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> N <br /> N <br /> SIGN HERE <br /> ignat re of own wilding contractor) (date) o o <br /> ZONING ADMINISTRATOR o: o <br /> N O N N M <br /> v TOWNSHIP P RMITS MAY BE REQUIRED N. rn o p n m <br /> � oi�SJo 000Ul <br />