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Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR - LAND USE - PERMITS F 3 <br /> F; O <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and U <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m L <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. — 0 <br /> y w <br /> o <br /> OWNER(Please Print) Contractor or Surveyor or Agent r o <br /> �3 A Dq//2 AV, <br /> Address Address <br /> City,State, Coe _ SoZ i City,State,Zip Code ' .t <br /> lb <br /> Telephone <br /> Telephone <br /> �•"� <br /> Permit(s)Applied for: P <br /> New Building Filling/Grading <br /> Addition Moving <br /> Sanitary Camping Unit o <br /> Privy ! Subdivision m <br /> Structure Use: 0 <br /> o <br /> (family home/cabin,garage,addi Z <br /> n,etc.) o c <br /> m <br /> Directions for plot plan drawing: ` <br /> t. 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 /> 6� <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 U <br /> the owner. n <br /> 6. 3 <br /> PLOT PLAN , 'R m <br /> v' c <br /> pzS-� Z a <br /> P a <br /> N <br /> 50 C V7 <br /> 1 <br /> , . -? I �' <br /> CD <br /> 14 <br /> Y�zrw��IG;leg N 0 <br /> b- <br /> S6 � <br /> 0 <br /> E 7bi^ All <br /> \ T <br /> rft o I� <br /> LG31989 I Uj <br /> co mvv�ra m <br /> a�5J m0 <br /> 9 2 N N a J <br /> not ave o o i 50� : m <br /> f�C�u r d C6f:hd Ea�rnar���n,zi�, jar �� 111QP �� ` m <br /> 10 <br /> I dec are that this application (including any accompanying schedule) has been examined by me and to the best ofmy b m m <br /> knowledge and belief it is true,correct and com tete.I acknowled a that am responsible for the detail and accuracy o '= m <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that <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 <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 above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> n n m <br /> SIGN HERE <br /> i gnat re of owy}�. r or building contractor) (date) o ! o <br /> ZONING ADMINISTRATO E T <br /> N N O N N m <br /> TOWNSHIP PERMITS MAY BE REQUIRED ry{Nu v v oou m <br /> `-' J7-- <br /> , `J0000000V7 <br />