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Burnett County Office of Zoning Administrator 00 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <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- 3 a <br /> tions of the State of Wisconsin. — o <br /> N m ^ <br /> O <br /> DOER(Pleas Print) Contractor or Surveyor or Agent <br /> m (U <br /> m <br /> Address Address <br /> ,a ien I,�/I �/?7a -L <br /> City,St le,Zi Code City,State,Zip Code <br /> �7/5 - SCoCv/ <br /> Telephone Telephone ' <br /> Permit(s)Applied for: CI <br /> New Building Filling/Grading <br /> Addition Moving O <br /> Sanitary ✓ Camping Unit o <br /> } <br /> Privy Subdivision o lc-w' <br /> ° <br /> Structure Use: /1/01-fie ° <br /> (family home/cabin, garage,addition,etc.) Z S (� <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 (OF). <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, <br /> ��engineer, bugder,contractor,etc.',the plans must be signed and dated by <br /> the owner 5/2�/ l/1/ 3� &/ WV�? �I� 7.3�N .�/6 c� <br /> Novi a ega escription on ttai e o i-h> rorm as on tax statement. o <br /> PLOT PLAN 3 N <br /> c <br /> Z o <br /> o a <br /> CU o <br /> Y <br /> fV <br /> a <br /> J n <br /> 0 <br /> O I}� <br /> 0 1) <br /> O <br /> N � <br /> T �I <br /> Z <br /> p <br /> Z <br /> D <br /> 5wimmff� p«�� ' 0 be > '15 �Fow. Ottww� o'e I � <br /> r <br /> �teS ti��Fu l ve5�fs f�c Sere-e v �n� �irs�" 35 8A<,V- �A <br /> p.l+.w.rn 0�-_ la k� -tv be Imo . ( esf` f C� ftJ <br /> mc m m w o a ca m <br /> 0 cr< 0n0a_m <br /> I- (n/ JJ l {� m a:� am =am <br /> U ro ZmDO oea <br /> Z o_ 1 <br /> O N: <br /> JN 2 : D <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my m y <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 /> € z. n <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 V; c <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 application. I agree to permit county officials charged with administering county ordinances or other authorized <br /> person to have access t9jhe 9bove describe emises at reasonable time for the purpose of inspection. <br /> T <br /> m <br /> SIGN HERE Iv [ E fn <br /> I ure f owner orb 'I g contractor) (date) <br /> ZONING ADMINISTRATO <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N O N <br /> N T T T O O <br /> 0 0 0 0 0 <br /> 0 0 0 0 0 0 <br />