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f ) " . / "j <br /> Burnett County Office of Zoning Administrator d o Z <br /> APPLICATION FOR — LAND USE — PERMITS '- 3 <br /> d a <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 <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 ol Wisconsin. o <br /> �n ��'J c� �� j y <br /> _ = ^ o <br /> a <br /> OWN E�t(Please RJ nt) Contractor or Surveyor or Agent <br /> / -J(—� /!� O` ) <br /> A� N /� Address `D• -,� , U� <br /> Ci a 1wn�, <br /> City,State, Coe G ; City,State,Zip Code <br /> Telephone Telephone a <br /> Permit(s)Applied for. <br /> New Building ( V 'I�lx'e� Filling/Grading <br /> Addition Moving p <br /> Sanitary Camping Unit a) <br /> O <br /> Privy Subdivision O < <br /> Structure Use: Basi eKK — � � �r%I C��IJI/��.��� 41he <br /> (family h melcabin,g e,addition, etc.) (�J f o o <br /> p 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. <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 /> 6 . si e o s orm as on ax s a emen . o <br /> PLOT PLAN 3 <br /> 9 y <br /> Z Q <br /> 0 <br /> jj <br /> Lu <br /> Semw0 <br /> iv r✓Yi� <br /> 0 <br /> N \ <br /> Z <br /> � O <br /> Z <br /> X <br /> Maacm�C /7o e /✓J� 6Q Ih ��Jv to�Q/ �IGCY^'� a m Cra. =am aa� <br /> Z' "' cmo � 3 <br /> N ' N 0 =Z <br /> O p': <br /> m <br /> o <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 /> information contained in this application(including an accompanyingschedule and I further declare that I recognize that n <br /> PP ( 9 Y 1 9 <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a <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 acces the abo a ribed premises at any reasonable time for the purpose of inspection. <br /> T <br /> N <br /> SIGN HERE <br /> (0d, o owner or b ild g contractor) (da1 <br /> `^ <br /> ZONING ADMINISTRATOR ;921 <br /> 0 <br /> TOWNSHIP PERMITS AY BE REQUIRED UNNNN. . <br /> 00000 0 <br /> 00000 <br />