Laserfiche WebLink
Burnett County Office of Zoning Administrator 0 0 0 o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and - 0 C <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 3 u <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- <br /> yogs of he St to of W' cousin. �® 5 w <br /> KLGkCLYYSSPf to <br /> m <br /> OWNER(Please Print) ^ Contractor or Surveyor or Agent <br /> 13 SA <br /> v lJOn vt(la y e m T m <br /> A dress Address g, <br /> ty,Sta ,Zip Code City,State,Zip Code �`� til"', <br /> ��3 � � V_)__3 �t o �,� � <br /> elephone Telephone �./I� Q <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving o {y� <br /> Sanitary — Camping Unit o" <br /> Privy I Subdivision 0 <br /> / 7 <br /> Structure Use: � <br /> (family home/cabin,garage,addition,etc.) o 0 <br /> a <br /> m <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. <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 /> 0 <br /> 0 <br /> 3 r <br /> a o <br /> Z <br /> 0 <br /> N <br /> _ <br /> v <br /> a <br /> i <br /> w: <br /> �C ao�leo� D o wlen <br /> Y <br /> � a m <br /> m $ n <br /> O p <br /> To fi <br /> 0 <br /> m I <br /> " O <br /> Z <br /> 0 <br /> Z <br /> ( /�y- 70 NVNrDDmy <br /> /U{f' '✓ _ U.l/ �-^' U �L) 'JQ V V'P K O m 3 <br /> Z o E E fD : E i <br /> W LA € m <br /> � �g ` = <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of —S <br /> my(our)knowledge and belief it is true,correct and complete. I (we)acknowledge that I (we)am(are)responsible for the <br /> E <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we)--.� ,� '• <br /> further declare that I(we)recognize that this information I(we)am(are)providing will be relied upon by the County of Bur- j d <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the _ 1 :0 <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- `(n' <br /> mises at any reasonable time for to purpose of inspection. <br /> m <br /> SIGN HERE i � <br /> (sig ure f owner or buil ing c r 00 (date) O 4 rt ? <br /> ZONING ADMINISTRATOR "� T <br /> pp: <br /> TOWNSHIP PERMITS MAY 6� REQUIRED000 <br />