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9 . <br /> Burnett County Office of Zoning Administrator m 'U -- 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 'z ° <br /> 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 /> �/ <br /> / y <br /> ,4x1e (1/S-ct„ 7BHY tr 1/cy�ls n <br /> OWNER(Please Print) Contractor or Surveyor or Agent o <br /> 35'75 rn1a �ra'7d A0 Y/IsZJr 1/�yL4n[ <br /> Ad <br /> dres L Address <br /> !� 11/ _ 13Cai tya17A".1� .G✓/'.�c. SYd'3o <br /> City,State,Zip Code City, State,Zip ode <br /> h, <br /> Telephone Telephone K <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition _' Moving o (e <br /> Sanitary Camping Unit n o <br /> Privy Subdivision0 <br /> �•�c� �, �¢•��eiar.+ter,. �- � o <br /> Structure Use: �• <br /> (family home/cabin, garage, addition, etc.) 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. <br /> 0 <br /> 6, rove a legal description on the side or this form as on tax statement. ° <br /> PLOT PLAN 3 <br /> a y <br /> C <br /> Z Q <br /> O n�� <br /> I <br /> I <br /> o j <br /> CCC777 <br /> o I o <br /> aj <br /> r <br /> 0 <br /> T <br /> dot Z <br /> 0 O <br /> Z <br /> 1 <br /> � m c�mmnacm� <br /> Q o o-a o aon_5 5.m <br /> ic <br /> 0 J m <br /> 1Y' Z p <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 o <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 1 g n <br /> information contained in this application includin an schedule and I further declare that I recognize that a : m <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 n <br /> person to have access to the above desch d premises at any reasonable time for the purpose of inspection. <br /> m <br /> m <br /> SIGN HERE 41_ <br /> (si a re of owner Ing contractor) (date) <br /> o: o <br /> ZONING ADMINISTRATOR o o <br /> TOWNSHIP PERMITS AY BE REQUIRED NNON+� <br /> In <br /> (T ITNim <br /> N <br /> 0000m <br /> 0000 oofA <br />