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Burnett County Office of Zoning Administrator C0 o o <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> d o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 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 ii <br /> tions of the State of Wisconsin. — o <br /> VT <br /> John & Sandra Biesterfeldt x <br /> m <br /> OWNER(Please Print) Contractor or Surveyor or Agent o- O f <br /> 2015 Wintergreen Ave <br /> Address Address <br /> Mt. Prospect, I1. 60056 <br /> City,State,Zip Code City, State,Zip Code <br /> (312) 299-0378 <br /> Telephone Telephone <br /> Permit(s)Applied for: _ <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit Gt <br /> 0 <br /> Privy Subdivision 0 -`.- <br /> _ <br /> Structure Use: "�� Q0T�l7Y� ° o <br /> v <br /> (family home/cabin, garage, addition, etc.) o 0 <br /> a <br /> m N <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. o <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 N <br /> the owner. <br /> n <br /> 6v e legalo <br /> description on the side f thisf ) 0 <br /> PL T�L form) as on tax statement. 3 <br /> a y <br /> Z C <br /> Q <br /> o a <br /> - A' s <br /> 0 <br /> I � <br /> se r <br /> S6NffR VE+3T <br /> n <br /> 0 <br /> _ <br /> g' o b <br /> = z <br /> t o <br /> 3? EB o r. V <br /> r <br /> o <br /> �e m <br /> w T <br /> �ROYosc'A u J R, m <br /> ADDrT f c nJ tri ( J t7' z <br /> ScC. �i& l.... I m�rnrDD y <br /> P,. .m <br /> n o•< = = n <br /> m a� C y <br /> 4? 3 <br /> Granted <br /> _ <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my � <br /> curacy of all <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and acm <br /> A : m <br /> information contained in this application(including any accompanying schedule)and I furtherdeclare that I recognize that p <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 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 /> T <br /> , q � <br /> SIGN HERE <br /> ( ' ature of ow r it ing contractor) (date) <br /> o' o <br /> ZONING ADMINISTRATOR <br /> N N ///(((+``y����1N <br /> TOWNSHIP PERMITS AY BE REQUIRED N N O IJ TU U gOIN <br /> IT <br /> 000b o m <br /> � o000 oVl <br />