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Burnett County Office of Zoning Administrator ( o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m UI <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m m <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 0. <br /> tions the tate of Wisconsin. = p <br /> m °1 <br /> /C/(_ n U' O <br /> OWNER(Please?7 PringContractor or Surveyor or Agent CA f`5 /00ii,/ Ave . <br /> d <br /> A r s; Address <br /> City,State,Zip Code City,State,Zip Code <br /> SU`C,�� '` <br /> Telephone Telephone <br /> I <br /> Permits)Applied for: <br /> New Building FillinglGrading <br /> Addition Moving o <br /> Sanitary Camping Unit n o \, <br /> Privy Subdivision 0 .`.- <br /> m r <br /> o <br /> Structure Use: v <br /> (family h me/cabin, g ge,addition,etc.) o 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. hV�JJ <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 /> side Or is orm as on tax statement. Oo <br /> PLOT PLAN 3 <br /> a N <br /> Z `v <br /> P a `Ay <br /> O <br /> N a <br /> N <br /> N <br /> N <br /> O <br /> J <br /> l7 <br /> N � <br /> O <br /> ~ � I <br /> Z <br /> O Z <br /> X c <br /> w aas <br /> 0 c = O o.-.m <br /> a < N N O = <br /> ZH[ o =m <br /> T. 3 <br /> o = : <br /> 2 m <br /> u 0 : <br /> g: E C <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 <br /> information contained in this application(including an accompanyingschedule and I furtherdeclare that I recognize that <br /> PP ( 9 Y 1 9 > : 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 y <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 /> 9 <br /> SIGN HERE � <br /> ( ' atur f own orb 'Id' g contractor) (date) <br /> /�7 <br /> ZONING ADMINISTRATORt-1 <br /> m <br /> TOWNSHIP PERMITS MAY BE REQUIRED c N <br /> 0a 00c)rnoo0000m�n <br /> 0000000Ul <br />