Laserfiche WebLink
Burnett County Office of Zoning Administrator w - o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 'z m <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. r <br /> !� I <br /> SAE FLL ;1dC — RP_eAJ P2 hI � Th� Q I r n O <br /> N <br /> OWNER(Please Prin ) Contractor or Surveyor or Ag M o <br /> ')002 <br /> � � m <br /> QOt Pla.t� R� .I " � JJ ISL?k . /Ji GY <br /> Address Address ��,3/1GC�� I <br /> L^ 1 �... <br /> C}ty,Stats Zip Code Ci' ,State,Zi JC de <br /> l eta �qO -4/ c9 �.\J�'S -3357kA <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading y-I <br /> Addition - X Moving <br /> Sanitary Camping Unit o <br /> 0 0 I <br /> Privy Subdivision 'm <br /> I o <br /> Structure Use: I&"- /U <br /> (family home/cabin, garage,addition,etc.) Z ° <br /> o v <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. 0 <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. a <br /> 3 <br /> PLOT PLAN o m <br /> Z o- <br /> o a <br /> L <br /> , <br /> P <br /> pQr , N <br /> pri � <br /> 00 0 <br /> Q \ <br /> cko%&41 . <br /> N <br /> . P" � olM'� /Joc.�y/�✓d � � <br /> lir b p� f o 0 <br /> el T <br /> �a <br /> CJW <br /> C <br /> m c�mm aacmm <br /> m aa� <br /> N p ='P <br /> OZ C <br /> N: A <br /> m <br /> o f s i c <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o m y <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all A m <br /> information contained in this application(including any accompanying 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 a <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 /> SIGN HERE <br /> (si atu of owner o ing contractor) (date) <br /> b: o <br /> ZONING ADMINISTRATOR " T <br /> J N O V m <br /> TOWNSHIP PERMIT MAY BE REQUIRED m <br /> 0000 <br /> 0000 y <br />