Laserfiche WebLink
-nett County' Office of Zoning Administrator c m o <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 m 00 <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 /> tiops1) Wi � `P/of thenState of co stm. <br /> N � <br /> 4oe4 � m D <br /> 2*R Please Print) Contractor or Surveyor or Agent a F <br /> Address�, Address <br /> tt � aT a b <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 o <br /> Sanitary �L Camping Unit <br /> Privy Subdivision <br /> Structure Use: i J l"f(..(// �/' I �`� a <br /> (family horbeleabin, garage, addition, etc.) Z o <br /> 0 0 <br /> m <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NS)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. c' <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. p <br /> 5. If,separate plans are submitted by an architect,engineer, builder,contractor,etc.,the plans must be signed and dated by f <br /> the owner. 1 <br /> O f� <br /> 0 <br /> 3 <br /> v o <br /> Z I <br /> 0 <br /> N <br /> c <br /> J n <br /> w' <br /> o <br /> o Jly 1�' <br /> 0 <br /> 0 to <br /> m <br /> m 0 <br /> 0 0 <br /> l) I\ <br /> � v <br /> m <br /> f5) <br /> A Z 0l <br /> dI(T1\Ll O <br /> 2 <br /> S <br /> m cm-mm nacmA <br /> 0 CL- -02 nam <br /> o < wo�3 <br /> v � m0 �m <br /> CZ M <br /> c m <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of 0 <br /> my(our)knowledge and belief it is true,correct and complete. I (we)acknowledge that I (we)am(are) responsible for the =- i i m <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we) ITI ; ' O <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 <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- <br /> mises at any reasonable time for the purpose of inspection. <br /> m <br /> SIGN HERE w o o <br /> (si tura of owner or ild.l*na contractor) (date) b <br /> �j � g o <br /> ZONING ADMINISTRATOR �-` i MNm1 <br /> `� L oo <br /> TOWNSHIP PERMITS MAY BE REQUIRED S8 000w <br /> J <br />