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Burnett County Office of Zoning Administrator m v Z <br /> APPLICATION FOR — LAND USE — PERMITS d 3 <br /> TO TUE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 5 _ <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 n <br /> tions of the State of Wisconsin. mo J <br /> �ANOnN �o�N I C� Ed = fi <br /> OWNER(Please Print) Contractor or Surveyor or Agent n y f <br /> Ad rpss /+/�- � Address m I <br /> 1 lir-MinA� � � ly M C n <br /> ACyy <br /> State,Zi Code City, State,Zip Code <br /> 123 - (neoJ , MV - �5511'5- (piz NZn-770"7 V � <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> J <br /> New Building ✓ Filling/Grading ` <br /> Addition Moving <br /> Sanitary Camping Unit O <br /> o J <br /> Privy Subdivision 0 �- <br /> Structure Use:— CAle 4 0 <br /> (family home/cabin, garage, addition,etc.) 0 0 <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. 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,engineer, builder,contractor,etc.,the plans must be signed and dated by <br /> the owner. <br /> Provide legaldescription on a side o is form) as on ax s a emen . o <br /> PLOT PLAN 3 <br /> P N <br /> Z a\ J <br /> Pi i <br /> N_3t j <br /> CD <br /> Cl)PC/� 0 r(�)/Jj 1 (l C <br /> � eC T <br /> (A) <br /> C�r m <br /> m <br /> o' <br /> N <br /> 0 <br /> 0 <br /> 0 <br /> O <br /> Z <br /> Z <br /> W y rnr DD W-0 <br /> m c �.mm 0ncm <br /> m <br /> =am <br /> co ^;ny <br /> a < "coo=3 <br /> N i N O )O <br /> UN: m <br /> of E c E C <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 <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 /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> t 1 N <br /> SIGN HERE <br /> (s g a e of r&�buildimg contractor) (date) <br /> ZONING ADMINISTRATOR / / - C'dZ <br /> OWNSHIP PERMITS MAY BE REQUIRED Cyp NNO J N <br /> I •1NN(T(TO <br /> C 00000' <br /> 0 0 0 0 0 <br />