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Burnett County Office of Zoning Administrator Z <br /> APPLICATION FOR — LAND USE — PERMITS d 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and y <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- V�1 <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 of Wisconsin. - o <br /> N <br /> SE �o c<t h02LE s C�s�ar. r��P <br /> 0 <br /> OWNER (Please int) Contractoro Surveyor or Agent n <br /> �9 ti U Pr.,r .57 Z Bax 13 w <br /> Address Address 77 <br /> ST' . PRULI tA �JT5119 Uj:U$S702 wI . 548`i3 7J- <br /> City,State,Zip Code City,State,Zip Code 1 <br /> BLDG --Fsl� l I <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building _� Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit ( .^ <br /> o 1 <br /> Privy Subdivision 0 m - <br /> r <br /> Structure Use: 24 X Z 8 (woRf G e> .j cow Cf% <br /> v <br /> (family home/cabin, garage, addition,etc.) o 'o _ <br /> a <br /> 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). J <br /> 2. Show the location of the well(W) septic tank(ST),and drainfield(DF). L3. 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 /> Provide legaldescription on a side o is orm as on ax s a emen . o <br /> PLOT PLAN 3 <br /> -0 y <br /> Z c <br /> a <br /> O 0 <br /> S a <br /> 1 � <br /> 1 tJ <br /> C (JI <br /> 0 <br /> t GR N o <br /> O _ <br /> I O <br /> p )vim <br /> T <br /> J C5 <br /> N 0 <br /> C <br /> M mrDD <br /> m -_.mmc. a <br /> n a< > > n a <br /> Z y a p <br /> 0 0 m <br /> . : <br /> � ' mE i�_ <br /> (, l y m <br /> t.Nu: `o ` ? D <br /> o c C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my _S: <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that a p <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 n <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> Q C N <br /> SIGN HERE T <br /> (signature of owner or Ilding contractoo ( ate) E o[ o <br /> ZONING ADMINISTRATOR <br /> »� <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 00000 ,o <br /> 00000 p <br />