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Burnett County Office of Zoning Administrator d o a <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 2 N L <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- - <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 n d <br /> tions of the State of Wisconsin. /]' `(� 'p <br /> rIA-1lle S /y °� Kj/4y� :�1 f� ate/ P w O <br /> O NER(Please 'nt) Contractor or Surveyor or Agent o <br /> r�gklaNd Pf° <br /> xsV Address <br /> Ive ro NkA /n n/ - <br /> City,State, ip Code f/ City, State,Zip Code -�-� <br /> L� / - �3.3 -.3`16 � <br /> Telephone 5-411 — - /95- Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving o Z <br /> Sanitary Camping Unit 0 O <br /> 0 <br /> Privy Subdivision <br /> r <br /> Structure Use: & v <br /> (family home/cabin,garage,addition, etc.) o 0 <br /> m <br /> Directions for plot plan drawing: .c <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. 0 ^ <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, 1 <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. legal p ion on the side of thisForm) as on tax statement. o <br /> PLOT PLAN 1 3 <br /> NV LA <br /> 0/c Z a <br /> o � a <br /> yo <br /> I = <br /> a <br /> 79 <br /> cp <br /> t = <br /> _ o <br /> 7) <br /> �` T <br /> El <br /> N <br /> �n� ) Z <br /> 00 <br /> m N Vrpr DD Wm <br /> = a <br /> am ay <br /> ado = <br /> - 3 <br /> = N: 9 <br /> declare that this application (including any accompanying schele) has been examined by me and to the best of my 0 <br /> knowledge and belief it is true,correct and complete. I acknowledge t at I am responsible for the detail and accuracy of all im <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize 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 c <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing w <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized a <br /> person to have a s to the above describe es at any reasonable time for the purpose of inspection. <br /> 9 m <br /> SIGN HERE /a'�/ <br /> (sig of owner or 'I g contractor) (date) <br /> ZONING A mISTRATOR Q om— l/� 0: o <br /> o; : o <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 00000 0 <br />