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7410 Co. Rd. K, 1102 <br /> 5dren, MI 54872 ' <br /> Burnett County Office of Zoning Administrator d 1 o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> ;v o 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 c �XN <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 n <br /> tion of the State of Wisconsin. <br /> J nn o <br /> � 0s f(?�� J h Ct�i�to 4x5 a o <br /> OW�EP(Please Print) X I I Contractor or Surveyor or Agent <br /> m <br /> Address f AdZs <br /> � r� edpvlc h Y <br /> City,State,Zip Code City,State,Zip Code " /b kA <br /> Telephone Telephone 1 <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit ct <br /> 0 <br /> Privy Subdivision 0 <br /> C. m <br /> Structure Use: o <br /> v <br /> (f mily home/cabin, garage, addition,etco <br /> m <br /> Directions for plot plan drawing: 1 <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. o <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. O <br /> PLOT PLAN a legalescrip ion on a side o is orm as on ax statement. 3 <br /> 'R N <br /> ^ J�N_ <br /> N <br /> _G O <br /> I m <br /> e <br /> c� <br /> 0 <br /> 0 <br /> N <br /> o � <br /> rV <br /> N <br /> Z <br /> O <br /> 2 <br /> X11 1 M <br /> M c m 0 D 7 <br /> n o o <br /> 9 _ d 0 <br /> N O <br /> Z O <br /> 0 m <br /> o 0 : O <br /> o; C <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of my 0 <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 ) gv' n <br /> information contained in this application includin an accom an in schedule and I further declare that I reco nize that O <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a <br /> ,ermit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing <br /> his application. I agree to permit county officials charged with administering county ordinances or other authorized <br /> in to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> N <br /> m <br /> F � <br /> (s" ature of owner or ilding contractor) (date) E <br /> 9STRATOR �- Ia�L//r IRn2 �Q71J <br /> T <br /> �TOWNSHIP PERMITS PERMITBE REQUIRED <br /> 0 0 0 <br />