Laserfiche WebLink
Burnett County Office of Zoning Administrator £ o <br /> APPLICATION FOR — LAND USE — PERMITS w 3 _ <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and - <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 3 n <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- <br /> tions of the State of Wisconsin. m <br /> zTmltt vl. sf hNSoN = <br /> OWNER (Please Print) Contractor or Surveyor or Agent n E <br /> o1Gq GRaN sTE ST• a <br /> Address Address <br /> Sr• PkIL mN ss►l <br /> City, State,Zip Code City, State,Zip Code <br /> eia i <br /> Telephone /a �e .d�l�jhane !J / <br /> Permit(s)Applied for: <br /> / K <br /> New Building V Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit <br /> Privy Subdivision o L <br /> y <br /> Structure Use: <br /> (family home/cabin,garage, addition,etc.) Z o r <br /> o � <br /> m <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 sgbmitted by an architect,engine r, builder,contractor,etc.,the plans must be signed and dated by <br /> the owner. VG cS b p/YJ/�( <br /> DQ <br /> o <br /> 3 r <br /> LITTLE V000 LfiKE A� Z p <br /> 135' N <br /> 1 IX ` ` '/ <br /> � N <br /> P <br /> CR6nJ as <br /> li <br /> m <br /> O o <br /> o'�Iti <br /> WKl St YK <br /> 178, TANK <br /> 9) 1, <br /> Z <br /> uRRtr4 Z <br /> f,EW <br /> �I r1 I me�m m o aM <br /> oa > > � aS-.m <br /> FL M <br /> N p ,f0 <br /> IIsi Q O <br /> m <br /> C <br /> I(we)declare that this application(incl•tding any accompanying schedule)has been examined by me(us)and to the best of <br /> my(our) knowledge and belief it is true, correct and complete. I(we)acknowledge that I (we)am(are) responsible for the m <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we) ' O <br /> further declare that I(we)recognize that this information I(we)am(are)providing will be relied upon by the County of Bur- <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the <br /> County of Burnett relying on this information I(we)am(are)providing in this application.I(we)agree to permit county offi- <br /> cials charged with administering county ordinances or other authorized person to have access to the above described pre- <br /> mises at any reasonable time for the purpose of inspection. - <br /> m <br /> SIGN HERETt11`�+� - `1� I - G� (`�',' '• r�i. <br /> v (signa wneror ildin contractor) (date) <br /> hi : op I o <br /> CG•nf� ) <br /> ZONING ADMINISTRATOR <br /> otitm <br /> WNSHIP PERMITS MAY BE REQUIRED o000000vl <br />