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-tl CL-d71v <br /> Burnett County ee Office of Zoning Administrator m v 1 z <br /> 0 CD <br /> TO THE ZONING ADMAINPI;TLI OR: The ATIONeFORherebLANDmakes PUSEn forPERMITS a Permit for the work described and '3 o <br /> 0 <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 0 <br /> tions of the State of Wisconsin. _ r <br /> i' <br /> OWNER(Please Print Contractor or Surveyor or Agent °' �f <br /> Address Address m <br /> r <br /> City,State,Zip Code City,State,Zip Code <br /> Telephone Telephone --Q> <br /> Permit(s)Applied for. r_ <br /> New Building _ Filling/Grading r, <br /> Addition Moving <br /> Sanitary <br /> Camping Unit <br /> Privy Subdivision o < (q <br /> w <br /> Structure Use: 4JQ` p' a�� Z - o -J <br /> (family homel abin,garage,addition,etc.) 0 0 <br /> 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 drainfieid(DF). l: <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 f <br /> 4. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building t lake, C) <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 dat by I I <br /> the owner. <br /> 6' ai e o is ore as on ax s a amen <br /> PLOT PLAN - 12�PA,a <br /> N <br /> Z c <br /> a <br /> o <br /> Ad ' ,\ �j a <br /> -O _ 1. M� ' 1 <br /> 20 -C o <br /> s4� <br /> Gr` K4, <br /> ) (n t <br /> wppppp �nn� m <br /> t S \ <br /> 2. <br /> ZA <br /> Boa <br /> J <br /> 0 <br /> `D �1 <br /> (Allam .0 <br /> f T' o z <br /> R' a <br /> Qr-1 <br /> WAI GrL. a '� R� <br /> ase weA*-1 78 G3 ` !a"" M U,- DD '`b <br /> 00 <br /> Z m O O <br /> O <br /> o : <br /> �i m <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of m S'• ` c? ' C <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of al <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that ` f ? p <br /> this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing g <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 /> SIGN HERE 7^���—•J v� [ E ' E <br /> (si •atur of own r or buil ontractor) (date) ` N <br /> ZONING ADMINISTRAT R J'�L -•� '• o E E <br /> • IJNOIJ��NT <br /> TOWNSHIP PERMITS AY BE REQUIRED rnrn naooam <br /> 88$$$$$ai <br />