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Burnett County Office of Zoning Administrator m o a <br /> APPLICATION FOR — LAND USE — PERMITS 3. :E — <br /> d o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 a <br /> tions of the State of Wisconsin. m o <br /> - <br /> a o <br /> OWN R Ple se Print) Contractor or Surveyor or Agent o <br /> ��� �. <br /> AddressSTS-S/OS- Address <br /> 15' <br /> City, ate,Zip Code City,State,Zip Code t^/) <br /> gyp- o �g <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition X Moving <br /> Sanitary Camping Unit 0 o <br /> Privy Subdivision m 15. <br /> Structure Use: W, e �'��fc��� ?� u ys✓ w a � <br /> (family home/cabin, garage,addition,etc.) 0 0 <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). <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, <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 /> 0 <br /> 0 <br /> PLOT PLAN 9 <br /> C <br /> Z O <br /> o a <br /> N <br /> O <br /> J <br /> /l <br /> Set A�r � �'� f ��aI-11 s <br /> s_ <br /> — See Pah f tt I63f) L( �:D,- 5'4', A. <br /> I <br /> a <br /> >r 0 <br /> 0 <br /> J <br /> N J ,) <br /> J <br /> 0 <br /> N � <br /> n c <br /> ZN G <br /> Z <br /> O <br /> i Z <br /> D <br /> J <br /> (nvtnr D Drp� <br /> n a< J J n a- <br /> m <br /> c w': Zmo �ic' <br /> 0 0: mZ 1 <br /> J : N: S <br /> di m <br /> O b: <br /> iD <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o <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 /> A <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that �, y 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 n <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 /> SIGN HERE+ <br /> (sa re of owner r ilding contractor) (date) o o <br /> ZONING ADMINISTRATOR '>t?1 - o <br /> T <br /> TOWNSHIP PERMITS MAY BE REQUIRED G N P,O J J m <br /> V TUN O <br /> 0 0 0 0 O <br /> 0000 O fA <br />