Laserfiche WebLink
Burnett County Office of Zoning Administrator <br /> APPLICATION FOR — LAND USE — PERMITS m <br /> z s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and v H <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 /> tiqns 9f the State of Wisc in. " o <br /> LAJA T <br /> MLCdA <br /> 0 <br /> OWN Plea e P 'nt) Contractor or Surveyor or Agent n F <br /> ! <br /> G 9 <br /> Addres%%''� '� -•� //� ,� �J <br /> W�� 1Z?/'- K/t 5 "�G<O f:3Address �? <br /> City,State,Zip Code City,State,Zip Code \ <br /> Telephone - Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading - <br /> Addition Moving <br /> v <br /> Sanitary Camping Unitm <br /> Privy Subdivision o <br /> Structure Use: t � 'e-ya�n^ j 0-4� 3cq y p o <br /> (family home/cab , garage, ad tion, etc.) Z <br /> o <br /> v <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North(N). o <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. r <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 <br /> the owner. <br /> O <br /> 0 <br /> o <br /> �+ <br /> N o <br /> (Ai <br /> C <br /> Q <br /> W <br /> o Z <br /> T N <br /> /ter 2 w <br /> r7 ro <br /> O p' <br /> _ <br /> gr—Io <br /> 2 _ <br /> r <br /> m � <br /> 2 <br /> 0 <br /> I p <br /> f <br /> :V fA v En r DDWy <br /> m n� nm nam <br /> o mE � mo �ao= 3 <br /> Z of <br /> o ` Q <br /> F we declare that this application(including an accompanyingschedule has been examined b me us and to the best of $ a C <br /> ( ) PP (' 9 Y 1 Y ( ) o: <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) ^'• p <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 ni <br /> County of Burnett relying on this information I(we)am(are)providing in this application, I(we)agree to permit count <br /> offi- <br /> cials charged with administering county ordinances or other authorized person to have access to the above described pre- m` ' <br /> m Z]: <br /> mises at any reasonable time f the purpo a of spect' n. , <br /> SIGN HERE / N <br /> o: <br /> (si lure f own r or b ' i c ra tor) (date) o; <br /> w o: <br /> ZONING ADMINISTRATOR a T <br /> 61JNOIV-� m <br /> TOWNSHIP PERMITS MA BE REQUIRED 00008 rm/J <br />