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7410 Co. Rd. K, 1102 <br /> Burnett County siren, Ml 54872 Office of Zoning Administrator m m o Z <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 'z 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 IN <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 0 r <br /> tions of the State of Wisconsin. <br /> C Ue�d✓1 /7 �i ebr� d/7 o <br /> a O <br /> OWNE (Plea P int) Contractor or Surveyor or Agent (� F <br /> 441' l//� A p <br /> Addre s Address 4 <br /> I_)e b sL/�s3 <br /> City,Sta a ip Code City,State,Zip Code <br /> U <br /> Telephone Telephone l �` <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Z Camping Unit n c> <br /> 0 <br /> PrivySubdivision 0 <br /> / N <br /> Structure Use: - nli.5�r\� �1n/(,/ °o n <br /> U " (family homelcabin,Oarage,additi n, etc.) o o <br /> m � <br /> Directions for plot plan drawing: ,� P <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. J <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 /> O <br /> LO gU e legalescrip ion on the side of this form as on tax statement. 3 <br /> 3 y <br /> Z Q <br /> 0 a <br /> • N <br /> I O <br /> ' <br /> O J P <br /> c14� <br /> �oU� <br /> 7' <br /> tzi G)EFm <br /> � O <br /> N IN. <br /> J <br /> m <br /> o ` <br /> T <br /> A N <br /> Z <br /> Z <br /> =j D <br /> NO <br /> m c�mmn ac�� <br /> n <br /> c v< JJOn-.m <br /> m n� - Cm �¢y <br /> s' °' cmo's3 <br /> o <br /> m : m <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 <br /> information contained in this application(including an accompanyingschedule and I further declare that I reco nize that Jv A <br /> PP ( 9 Y ) g O <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 described premises at any reasonable time for the purpose of inspection. <br /> T <br /> SIGN HER <br /> (si ur o owner or��lJ+it ng contractor) (date) <br /> ZONING ADMINISTRATOR -� r fG <br /> 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED NNcnOrn�nooN+8Nm <br /> ut <br /> 000000ino U) <br />