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BUm'ett County Office of Zoning Administrator iuo 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and u <br /> ° L <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m (U <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. V! <br /> y O <br /> C <br /> � <br /> o �r F <br /> O R se P ' . Contractor or Surveyor or AgentANNE J o� C�L _1,�1 r' I7��/� _ n <br /> Address /47q At fee— / Address <br /> City,State,Zip Code City,State,Zip Code ,r <br /> v ` \ <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading �$ <br /> Addition Moving o ro <br /> Sanitary Camping Unit t7 > <br /> 0 <br /> Privy Subdivision 0 <br /> m � <br /> iif' TJa <br /> Structure Use: N� -- ° <br /> v <br /> amily homelca in,garage,addition, etc.) o <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). <br /> 2. Show the location of the well (W), septic tank(ST),and drainfield(DF). (jl <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. �v y <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 /> O <br /> PLOT PLAN description on a side o is orm as on tax statement. 3 <br /> 'R y <br /> Z c <br /> o U a <br /> V N <br /> o <br /> I J <br /> 70 �f o <br /> D� Rrgrssll C <br /> caT d4-4 <br /> > <br /> 26' sr Q <br /> 3� <br /> V ) Z <br /> ^ � O <br /> 621 uE 141, ) <br /> c_ m >>o' <br /> 9: <br /> T. wo3 <br /> Z p <br /> � <br /> w O J O <br /> z 1 <br /> m <br /> 00 gi i IS <br /> co c C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the I est of my __. o <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and acc racy of all — m <br /> PP (including Yaccompanying 1 g A <br /> information contained in this applicationan schedule and I further declare that I rec nize 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 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 w <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 /> N <br /> SIGN HERE <br /> (si to re of o ner=building cont actor) (date) <br /> o: o <br /> ZONING ADMINISTRATOR �A! o I I o <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N O J N m <br /> u�o��n o.8 nm <br /> �jobbobb$ <br /> 000000 N <br />