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Burnett County Office of Zoning Administrator d0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> w o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and w <br /> 00 <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m m J <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. bi <br /> N _� <br /> N <br /> EC/G G. GyEY � O <br /> n O <br /> OWNER(Please Print) Contractor or Surveyor or Agent o <br /> 0 <br /> m <br /> Address 16,97 <br /> 6g7 dry i2o Address <br /> City,State,Zip CodeCity, State,Zip Code <br /> SP o dF—, (Ui s o <br /> Telephone / Telephone <br /> Permit(s)Applied for: n <br /> New Building Filling/Grading <br /> Addition Moving v <br /> Sanitary Camping Unites 0 o <br /> Privy Subdivision <br /> r <br /> E; o <br /> Structure Use: / n <br /> (family home/cabin, garage, addition,etc.) o V 1 <br /> IWAy / - Ocr 31 <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. <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 /> O <br /> Provide ego description on a side o is form) as on ax s a emen O <br /> PLOT PLAN .a rn <br /> Z v <br /> o a <br /> � 1 <br /> N <br /> O <br /> 1 <br /> rC <br /> 2 �2 7-0 14D leeille e15 t9L",7-.5 <br /> See 1 �11 <br /> � Cs le-est v� <br /> a <br /> O <br /> 0 <br /> N <br /> O <br /> 7 ^/ <br /> ro 1V <br /> O <br /> n <br /> N 7 <br /> Z <br /> O <br /> Z <br /> I <br /> 21 fn Vfn 1-DDWM <br /> m c �.mmmacm <br /> n U< > > n=am a- <br /> o a ' m c m 0 3 <br /> w m o <br /> to <br /> m <br /> M <br /> UN: cc a <br /> 6` o c [ 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 m <br /> PP (including Y P y 9 ) g <br /> information contained in this application includin an accom an in schedule and further declare that reco nize that a : O <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 a <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> m <br /> SIGN HERE <br /> (signature ofWrnt or building c /ror) (date) o o <br /> ZONING ADMINISTRATOR / <br /> o: o <br /> SHIP PERMITS MAY REQUIRED � ���N 00m <br /> O ,m <br /> 1 �/j <br />