Laserfiche WebLink
Buirnett County Office of Zoning Administrator co -o c <br /> APPLICATION FOR — LAND USE — PERMITS 0 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and o 0 <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 /> ,,o%cWcStayon <br /> w� i�sroiu <br /> OWNER(Please Print) Contractor or Surveyor or Agent ii F <br /> 32 H <br /> AddressAddress <br /> ,S7_/1LA//)r_'Vj M//yN <br /> City,State,Zip Code City,State,Zip Code i <br /> /— 6/2- 439- /51y <br /> Telephone Telephone Sj <br /> n <br /> Permit(s)Applied for: � <br /> New Building _ Filling/Grading <br /> Addition Moving <br /> 0 <br /> Sanitary Camping Unit fi <br /> Privy Subdivision o <br /> o <br /> ll�� <br /> Structure Use: �E 17Nt> <br /> (family home/cabin, garage,addition,etc.) Z <br /> 0 0 <br /> D <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). o <br /> 0 <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. a , , <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, W <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 /> 3 <br /> r Z » <br /> N �f3► <br /> NSA X61 C <br /> S <br /> C°H131rV I <_: <br /> mcm <br /> co <br /> ti <br /> UT <br /> �. o <br /> U � <br /> � t b <br /> Z <br /> Z <br /> x <br /> ! X c-0diu>nca-0 <br /> n Q< 000n_m <br /> Co -'--3 <br /> i 2 : : m <br /> o � c <br /> )declare that this applica n(including any accompanying schedule)has been examined by me(us)and to the best of i <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- p: <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the iI P: <br /> County of Burnett relying on this information I(we)am(are)providing in this application. I(we)agree to permit county offi. [ to <br /> cials charged with administering county ordinances or other authorized person to have access to the above described pre- E ' <br /> mises at any reasonable time for the purpose of inspection. � I �; '• <br /> SIGN HERE��� <br /> V: O <br /> (sig re of own r building contractor) (date) <br /> ZONING ADMINISTRATOR T <br /> TOWNSHIP PERMITS MAY BE REQUIRED �o �000l <br /> �; <br />