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Burnett County Office of Zoning Administrator m m o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and �2 m <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 M ) <br /> tions of the State of Wisconsin. <br /> 0 <br /> X %NNETH LAR ON C � c�c <br /> OWNER(Please Print) Contractor or Surveyor or Agent o Q <br /> l 555 y koUNL7 LAKE Agl_Vvo a "- <br /> Address Address <br /> 19 /vMA/ <br /> City,State,Zip Code City,State,Zip Code N <br /> Telephone Telephone 0 <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving p <br /> Sanitary Camping Unit 0_ Gt <br /> 0 <br /> Privy ,1L_ Subdivision 0 <br /> Q� w r <br /> Structure Use: � //5;_A <br /> v <br /> (family home/cabin, garage, addition,etc.) o o' <br /> a <br /> w <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 /> the owner. y f <br /> LO �?XAde legal description on the side of this form as on tax stat LAY <br /> C 0 m ^ <br /> Z Q <br /> _ yJ ATR 2 _ <br /> U—j 1 <br /> LoT 10 <br /> LOT 1 ) o <br /> M r (_urn <br /> 2 <br /> /p f y <br /> 1 n <br /> 0 <br /> o o <br /> E 26x28 <br /> NS Rt v 4y4- <br /> �. v /op <br /> x, 5o F7" d 13 CD <br /> AQPRO <br /> FROM t✓. > 1NE 2 ` @� 4� 7° <br /> F <br /> %\O <br /> m`t 7n <br /> GR >=E � EQ 1za � <br /> �. AR <br /> / V p �v�rDDW� <br /> �fl✓ M Q<> > 0aaa . m <br /> C .l-. Z in `zwo 0ro3 <br /> 14i GH U/ fly o �? I : a ; € <br /> e: c m <br /> r <br /> o c C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my —0 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that r: A m m <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 a ' <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> SIGN HERE 3'I3 -'g /n <br /> (sig re of owne building contractor) (date) Ul c o <br /> ZONING ADMINISTRATOR <br /> N m <br /> TOWNSHIP PERMITS MAY BE REQUIRED cn U` o, <br /> �o 0000 co <br />