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durnett County Office of Zoning Administrator w - o z <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 m <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- <br /> tions of the State of Wisconsin. - o <br /> N d <br /> N � <br /> p�-h a 1 o <br /> 0 NER(Please Print) Contractor or Surveyor or Agent n <br /> Address Address <br /> City,State,Zip Code City, State,Zip Code <br /> .3,;_ 7 fsb`9 <br /> Telephone Telephone <br /> Permit(s)Applied for: ¢ <br /> New Building Filling/Grading M <br /> Addition Moving o <br /> Sanitary Camping Unit 0 O <br /> o _� <br /> Privy Subdivision - o ,`.- <br /> G � y �9 o <br /> Structure Use: � fv <br /> (family home/cabin, garage, addition, etc.) o o <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. 6. Provide legal land description. n <br /> PLOT PLANO-3�r <br /> , 13v+ I d M w + I L b 3 <br /> ala iQ ' 7c6,om rhe .e,>sr A H� Z Q <br /> .Vcr PS S`O rhe o*'vie Faf- a y Tor,.�•r fVo�rl Ceyf 7•Fi R , p <br /> u-, , <br /> -j- (�u+ 14, l'�9 airr <br /> YXiG s3�, 6' pro <br /> ip9 . <br /> J <br /> 7hq L,,-/ a c> F The >� J/ of 7-hhlP Yt vv ,� of secr,oy� a9 Towhs�;p <br /> �XD N eF rail t l �f Wxc.r 3,Ais <br /> tpeY, nnir/Y kT Thi Nu' CnrwrV r 40rl� pe C; Di9 a9 <br /> sQc7, <br /> powHs4iP yr A' west T6Qyrcyo dor c>? <br /> r3 l�.s Thence n P uo <br /> hin 'j grD reds. SoVTh � colYlcf �c� k z <br /> X!t'e�tce lw IGS ' rc rhe Pe ,',zT CF <br /> 46 100, " <br /> p,.r >7 err c <br /> �t �ifly I <br /> scant r'aw� s•��p � <br /> p N�cnr DDW <br /> m c <.mmn c <br /> n o'aoo n -. <br /> o Z <br /> O <br /> O 0 <br /> Fri <br /> o O <br /> o C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 'Mo <br /> 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 reco nize that <br /> PP ( 9 Y ) 9 O <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a cy $ <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 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 /> SIGN HERE t����ss� �••-v7.� `- �"� <br /> i ature of o r or building contractor) (date) <br /> o: o <br /> ZONING ADMINISTRATOL Lr <br /> o o <br /> TOWNSHIP PERMITS MAY BE REQUIRED O NT NT N N O O o T <br /> 000000c <br /> 0000000 <br />