Laserfiche WebLink
,f <br /> Burnett County Office of Zoning Administrator W - 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 -0y 00 <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 0 <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- — <br /> tiong-of the State of Wis nsm w 0 <br /> _e <br /> m o <br /> OW R Please-Print) Contractor or Surveyor or Agent n F <br /> Add , I I 111 \ Address <br /> City,State,Zip Code 11' J City,State,Zip Code t <br /> Telephone Telephone <br /> r <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit <br /> Privy Subdivision 0 <br /> Structure Use: <br /> v <br /> (family hometcabin,garage,addition,etc.) o 0 <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 /> O <br /> 1 Q� 0 <br /> I ��� ,i✓Lo1 p o <br /> Z <br /> w <br /> y <br /> 3 <br /> N <br /> 0 <br /> �I <br /> �fr '3pp <br /> cop/1 (Jli �s 21 <br /> Srpp7f� z <br /> AN1 yYi'LL ° <br /> M Wvmr DDo7y <br /> 000 cc�,W> W> o 0a- <br /> O.cm <br /> < <br /> m a� -'a5's <br /> 0M <br /> N <br /> ' 9 <br /> CZ» ' m <br /> Cc <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of 0: m <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) 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 o <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- p <br /> mises at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> o: o <br /> '�i ure of owner or wilding contractor) (date) E o E E [ o <br /> ZONING ADMINISTRATOR <br /> IVNOIV� NT <br /> N T TNO T <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> oo$oo o <br /> L <br />