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Burnett C"nty Office of Zoning Administrator ( M o � <br /> APPLICATION FOR - LAND USE - PERMITS 3 <br /> O <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 57 <br /> N <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m `m <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 /> I, I yn/I N <br /> iCuc. Uiu� 1 /I� IP� i ¢yS a O <br /> OWNER(Please Print) Contractor r Surveyor or Agent <br /> uo � <br /> � e>> < � t L6u br (Yat) 04, �. _ m <br /> Addre$��{ /� Addr ss ) <br /> VI �D c�la7�u r�oh MK JS4/�i � �ti�4..�n Lc.7iS _��4+'3 L. <br /> City,State,Zip Code I —c� City,State,Zip Code (7 <br /> Telephone Telephone Qj <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition — — Moving o <br /> Sanitary Camping Unit o <br /> Privy Subdivision 0 »- R <br /> ., y„ `- 22X2f% ��tihcck� CC, �. �( I. o <br /> Structure Use: z --�' S�= �c��l'. �o o <br /> v <br /> r (family home/cabin, garage,addition,etc.) . o v <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. <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 /> theowner. 6. PROVIDE LEGAL DESCRIPTION AS SHOWN ON YOUR TAX STATEMENT. <br /> O <br /> o <br /> PLOT PLAN QLJ A.pi- 'P../Ef _/. a c <br /> I Sl�w� sus ev:a-(wT/�l � Z n <br /> ry <br /> IV <br /> b 'y, Q m <br /> Q <br /> J <br /> ON <br /> / J <br /> / J <br /> 2.,as ..y I `o <br /> 0 <br /> I z <br /> I <br /> . I <br /> ��� I i�h5 f-U rc�Pa.nchf �A�`� li-SSe SSar S'/R�cC �r�/:ti, 1.✓D✓✓'4t n Q<' ' n n�m <br /> Iticre`�a2 U ^u 131 �rny d/S.dO° —f/G doJ . CA" ioe�d� S� @ab>na o = 2 H o=; <br /> _ /�cr 2 N <br /> y.: m O J 0 <br /> 14.kd Yo be /'�doa. p(J ( so f�t� oac�P� ✓cls_ re /b� 0 o <br /> /t'v'� ' c s0� , vT ° cn i s <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my � <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m i m <br /> information contained in this application(including an accompanyingschedule and I further declare that I reco nize that A <br /> PP (� 9 Y ) 9 <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 <br /> person to have access to the above de cribed premises at any reasonable time for the purpose of inspection. <br /> T <br /> N <br /> SIGN HERE ^-r - Z's1<w �'� /787 <br /> (sign r of owner or buil i contractor) (dale) o o <br /> ZONING ADMINISTRATOR o o <br /> N N O V m <br /> TOWNSHIP PERMITS MAY BE REQUIRED �0 ^c^o o m <br /> 00000 y <br />