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G►� CC7 <br /> Burnett County Office of Zoning Administrator m v 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 <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m c <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. <br /> CA y o <br /> o <br /> OWNER(Please Print) Contractor or Surveyor or Agent a <br /> 60 4 L A*A VSc>Q_Q -b ° <br /> AddressAdd <br /> ' <br /> ress <br /> W1 54880 N <br /> City, State,Zip Code City,State,Zip Code y <br /> 71s- 3�T 2 3 <br /> - 42-2- 3 <br /> Telephone Telephone W <br /> Permit(s)Applied for: 2 <br /> New Building x Filling/Grading M <br /> Addition Moving W ° r <br /> Sanitary Camping Unit <br /> 0 <br /> Privy Subdivision 0 4 <br /> y r <br /> AESSp Ry $u Lo 1�� A� ° <br /> Structure Use: <br /> (family home/cabin,garage, addition, etc.) 40C> o <br /> Directions for plot plan drawing: (a N� <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). r� <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. r1) a <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. U <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 /> 6PL f�LA a ega escrxp ion on a si e a is orm as on ax s a emen o <br /> 3 <br /> 'D N <br /> / e a f� {CCES30Ry o (� n <br /> 6t�STi..iGT L G p o N <br /> 22=0" <br /> --J0(1 <br /> I <br /> a •� N <br /> vi r <br /> co <br /> n <br /> _o4MA/�/ELo S�pj/C <br /> V /s 4W 571AJG. JA fo 0-0 � (A <br /> ao 0 ALB Cv7 /,V4t[Eo Qv t o (Z► <br /> 5131178 <br /> tU Ctw�v7Y �/T ,r 6aG9 ? <br /> 21 A�4 Srs.TE '01AWAqf7 dr <br /> �r 22=0 r — <br /> 0 <br /> � Z <br /> k' V^! M p7L� QI Q % U' <br /> ` . (V <br /> Q <br /> y A C � (nv(ArDD W� <br /> 00 Ra C m <br /> O < d C N <br /> GQxi/LO/.v6 Z 2 ° <br /> FOPv. o 3 <br /> r p«r= i m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m <br /> PP C 9 Y 1 Y y <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy : m <br /> information contained in this application(including any acc ying schedule)and I further declare that I recognize that A p <br /> this information I am providing will be relied upon by thein f Burnett Wisconsin in determining whether to issue a E o E <br /> permit.I further accept all liability which may be a result of the ty of Burnett relying on this information I a oviding o <br /> in this application. agree to permit county officials charged administering county ordinances or other aUhorized �' ' <br /> person to have access to the above described premises at any?re onable time for the purpose of inspection. d' <br /> T <br /> SIGN HER <br /> (sig a of own ing contracto (date) [ N <br /> 1 0: : o <br /> ZONIN ADMINISTRATO <br /> IX <br /> `� LO�pWetFtTP PERMITS MAY BE REQUIRED �N N N O USN <br /> o 0o <br /> m <br /> b) '31. 7AC /lc ( J 5 <br /> Ro" !n <br /> � 36�t 7o U. W . <br />