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"'f `: ' 0_i � <br /> Burnett County Office of Zoning Administrator m M 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and w �. <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m `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. y o L4 <br /> N <br /> FrkV" Irving a E o <br /> OWNER(Please Print) Contractor or Surveyor or Agent M <br /> 17�5' Td �w wt S t <br /> Addresst Address <br /> SPawl , M�,. ,s113 <br /> City, State Zip Code City,State,Zip Code <br /> tYz� d 4�I- 756a � <br /> T—elephone%W 1 (77/5)—2 S}- ]7O.(> Telephone <br /> Permit(s)Applied for: b <br /> New Building Filling/Grading ( , <br /> Addition Moving QHS <br /> Sanitary Camping Unit o <br /> Privy Subdivision y <br /> 11 1 LL l r <br /> Structure Use: -3 S eo Sey�, V o v-c/k A d d r { IONS 1 0 c s- b 1 Y\ Z <br /> (family home/cabin, garage, addition,etc.) o <br /> m <br /> a <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. ,or„ <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. O 'V <br /> LO �tXA a ega escription on the side of this form as on tax statement. O <br /> a ar <br /> c <br /> Z o <br /> JC.J <br /> N <br /> O <br /> b t <br /> s�j ea <br /> d <br /> uF — <br /> s� a <br /> 'sr <br /> o <br /> o <br /> m <br /> N <br /> o <br /> w6 y <br /> 1 j T <br /> � j Z <br /> U5 r 1 Z <br /> IH <br /> DD eer L&�K% D nvnr m� <br /> sc4�a 40 ft � Q<0.amEim <br /> m a� ,.nm � S <br /> U): M <br /> d C 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 J= m <br /> information contained in this application(including an accompanyingschedule and I further declare that I recognize that n O <br /> PP C 9 Y ) g <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 n <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 bove described premises at any reasonable time for the purpose of inspection. <br /> T <br /> N <br /> A <br /> SIGN HERE <br /> ilding c rector) (dte)(si atu of owner <br /> o <br /> b: b <br /> ZONING ADMINISTRATOR o; o <br /> IVNON�{"�Nm <br /> TOWNSHIP PER ITS MAY BE REQUIRED m <br /> � ogo 0000l'A <br />