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,� <br /> Burnett County Office of Zoning Administrator W m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 'z 6 ' <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 0 c <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. <br /> �a rr y y S her/u M /(��/�� <br /> N � <br /> C <br /> fD <br /> n _ F <br /> OWNE (Please Print) Contractor or Surveyor or Agent J <br /> / 7/3 E: 89711 5r <br /> AAdress Address ) <br /> /V Ofj.rr hI /'?/Vi <br /> 5 yes �. <br /> City,State,Zip ode City,State,Zip Code <br /> Telephone Telephone <br /> Permits)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving yy 0 <br /> Sanitary Camping Unit L— o 0 <br /> 0 <br /> Privy —X— Subdivision 0 .`C. <br /> N <br /> Structure Use: r rr + 0-ef ` f I v <br /> (family home/ abin, garage, addition,etc.) o <br /> m <br /> Directions for plot plan drawing: (3�C I Ude CY3Yll�Ep, `A- <br /> 1. <br /> t'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). f <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 ry <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, i <br /> river or stream, if applicable. P <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans mus a signed and dated by <br /> the owner. <br /> FfLOTr�L�A�J a ega escription on the side of this form) as on tax tatement. 3 <br /> v N � <br /> CAMPER FOR 6 MONTHS: FROM Mo /S �Jll TO , /5 �yay o a g <br /> N <br /> 70/ <br /> \ 7�� <br /> 6X ! t �j <br /> i 7 j' (03) -10 <br /> N o <br /> / O )6 <br /> T <br /> / Z <br /> Pv i 70 0 Z <br /> 6x6 <br /> CNS <br /> w <br /> a �� r�rr�+etisian 190 3ca' � <br /> a.he es�ir`vrcio�i <br /> A D a m <br /> Q, P1 �4y VGIYY I N O.� J -�a'a�0 <br /> N J <br /> Z p' <br /> b /� RJ, <br /> /' <br /> i 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 of all ; m <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a n <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 described premises at any reasonable time for the purpose of inspection. <br /> m <br /> SIGN HERE <br /> ig ur of owner g contractor) ( ) v <br /> ZONING ADMINISTRATOR <br /> • fn T <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> o !of 601%1 <br />