Laserfiche WebLink
Cts C C-rIN-1-) <br /> Burnett County Office of Zoning Administrator (r ' o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and io <br /> w <br /> located as%hown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m E <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 n r) <br /> tions of the State of Wisconsin. = o <br /> m w <br /> P9'� f k o Mn q S a = t o <br /> O NER Please Print) r Contract r Qr Surveyor or Agent y <br /> i,., 6j l�i �r n r 0 r m <br /> Adqo�res Address <br /> 1,res wt . <br /> City,State,Zip Code City,State,Zip Code I A <br /> Telephone Telephone <br /> Permit(s)Applied for. <br /> New Building K FillinglGrading a <br /> m <br /> Addition Moving o S <br /> Sanitary Camping Unit 0 3 <br /> Privy Subdivision 0 'C. <br /> po ° <br /> Structure Use: � +�" ��d .! O <br /> e � C `L C ?nr A- v <br /> (family home/cabin, garage,addition,etc.) a 0 <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. S <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. 7 <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and dated by 1— <br /> the owner. `�" <br /> n c} <br /> 0 <br /> PLOT PLAN - 3 <br /> nq <br /> (v Z a <br /> o � n <br /> MI \a ` o <br /> N � <br /> 3 / �4 �A U <br /> _ o <br /> 7 <br /> NB �W ° c <br /> , <br /> F— dz <br /> 50 <br /> 05T �� --° <br /> 0 <br /> N <br /> 130, 8S o <br /> Z <br /> I ' <br /> m0 o'OGN �[ d >om <br /> m n7 n <br /> n <br /> O J <br /> C0 <br /> O <br /> Z O 1 <br /> O > : <br /> N: <br /> �i :' ; m <br /> S <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my S: m <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 any accompanying schedule)and I further declare that I recognize that a O <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a <br /> 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 p <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> N <br /> N <br /> SIGN HERE <br /> (sign ure of owneror building contractor) (date) <br /> o: o <br /> ZONING ADMINISTRATOR S i i i S <br /> TOWNSHIP PERMITS'MAY BE REQUIRED �PN " <br />