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Burnett County Office of Zoning Administrator cr, 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and N o <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 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. <br /> 0 <br /> frti� m�`,�M �a f l���or �UIc� Etaejy ep — a o <br /> OWNER(Please Print) Contractor or Surveyor or Agent o ( I'► <br /> Add resLt� � 0� `410/ Address x� <br /> City,State,Zi Code City, State,Zip Code <br /> � <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building FillinglGrading <br /> Addition Moving o Sr, <br /> Sanitary Camping Unit n G) 4 <br /> 0 <br /> Privy Subdivision <br /> (12�5[C�P►�� Aerw, {'t�1 (C 1 cl o + ulwlu� oN - SY�eRS s T <br /> Structure Use: v <br /> (family home/cabin, garage addition,etc.) 0 0 <br /> a � <br /> m <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 M <br /> the owner. " <br /> 44 n <br /> 6PL f?LANe ega escri�p ion on a side of this form as on tax statement. 3 <br /> a N <br /> G �/�y� Z <br /> `Iro V e, / G' o a <br /> r � <br /> - I:C' 1jG3u <br /> I Flu. N P <br /> � o <br /> OT, U! <br /> /+ m <br /> / _._.. If O <br /> S1 r, 1IIry0nL/7+J[�, <br /> 0 <br /> O <br /> I J <br /> p T <br /> tor(/7 o C <br /> 'w <br /> o <br /> 93 <br /> m e- wo o nc <br /> a a 0 n n n- <br /> ��`.ttO Wtfl�Q OZ 0 : A� <br /> »: 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 ��� m m <br /> PP (including Yaccompanying ) g n <br /> information contained in this application includin an 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 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 ` m <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized n <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> A m <br /> SIGN HERE `�"x>®>/>t— /+� , ' CC�r <br /> c <br /> ( Mcf owner o b Ing contractor) date) I I <br /> ZONING ADMINISTRATOR /y'7 <br /> o 0 <br /> TOWNSHIP PERM S MAY BE REQUIRED o m <br /> 0 C fm/7 <br />