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Burnett County Office of Zoning Administrator iu M o a <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 6 -� <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. p <br /> N M <br /> Clare Lidel Donald Dani '_ <br /> e3 m n 0 <br /> n f <br /> OWNER(Please Print) Contractor or Surveyor or Agent oo � <br /> Rt. 3 n0 Box 316 <br /> Address Address <br /> ;Y <br /> Frpriprinr GIT 511837 .C+rpn� GIT )4R77 <br /> City,State,Zip Code City,State,Zip Code <br /> -�1 25 71TTi11 5533 <br /> Telephone Telephone <br /> 1 <br /> Permit(s)Applied for: CX; <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary X Camping Unit i3 Gig. <br /> of <br /> Privy Subdivision 0 <br /> qq�� m r <br /> �-MiN T�ho 0 <br /> BirUCtUfB Use: � 2U OOL V � <br /> (family home/cabin,garage,addition,etc.) o v° <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). �v <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. (J( <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 N <br /> the owner. <br /> n <br /> Provide ega description on a side o is orm as an ax statement. o <br /> PLOT PLAN 3 <br /> P m <br /> Z nc <br /> o a <br /> See State Appro,red plan <br /> yJ <br /> (S` N <br /> V.i <br /> (n <br /> m <br /> n <br /> 0 <br /> N <br /> O N <br /> O � <br /> O <br /> n <br /> T <br /> d <br /> N <br /> Z <br /> O <br /> Z <br /> I� <br /> m c 70 <br /> 0 ncmM <br /> n a< n no.-.m <br /> To. mf a= <br /> 0 5 w F. 3 <br /> O OJm <br /> Z O Z 1 <br /> O <br /> N; m <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 /> PP (including Yaccompanying ) g A <br /> information contained in this application includin an schedule and further declare that recognize that A : 17 <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a 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 m <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized c <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> J N <br /> SIGN HERE /VY"�!'A�••✓y:•(/� 11�13/sQ of . <br /> (signal ff/owner or"ding contractor) (date) <br /> A/ <br /> � E i <br /> ZONING ADMINISTRATOR �� o o <br /> WNSHIP PERMI S MAY BE REQUIRED <br /> or <br />