Laserfiche WebLink
�umett County Office of Zoning Administrator ; £ o <br /> APPLICATION FOR — LAND USE — PERMITS d 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m <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 /> tions ofM/+�e State m <br /> KOefr p;xyiso» <br /> o <br /> OWNER(P ase Print) Contractor o urveyor or Alent a <br /> Addre� . rB� 6e /tT-J �h. S- Address /_ /, 5 <br /> W� ,S07S G(/ CCS- <br /> City, State,Zi Code City,State,Zip Code r� <br /> �r✓/� - ,«S- £-' Y4 / 7i5' yG� /7pg' <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building X Filling/Grading <br /> Addition Moving a <br /> Sanitary Camping Unit <br /> Privy Subdivision 0 <br /> Structure Use: f�Qr��� o <br /> (family home/cabin, garage,addition,etc.) z o ry <br /> 0 0 1 <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. o <br /> 4. Show dimensions in feet of the following:(a)building�t'4 aU V E!'r5)bu YdiuA 1b.CerRer line of road,(c)building to lake, <br /> river or stream, if applicable. F/G !!G L%7�C.� <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 /> U� w6 3 <br /> a <br /> 5'T i <br /> w <br /> a <br /> a <br /> Y � w <br /> 0 <br /> ev �f <br /> 1 � co' <br /> ar <br /> 0 o <br /> p- <br /> ICI N p z <br /> M aam� <br /> dAj <br /> o v<> > 00 a S.m <br /> a� am_ m m O J 0 <br /> y: S 2 : ? m <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of <br /> my(our)knowledge and belief it is true, correct and complete. I (we)acknowledge that I (we)am (are) responsible for the i m <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we) `n `. t3 <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 i i 1 ;d <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 the purpo a of insp tion. <br /> Q dr i <br /> SIGN HERE a � �D `� : <br /> O: <br /> (si a of ner or bui ing ntr ctor) (date) <br /> c : <br /> ZONING ADMINISTRATOR ` ` '• <br /> NNOIU� N <br /> l � tP fn fTNO <br /> WNSHIP PERMITS MAY Bli)REQUIRED 0 0 0$8 0 <br />