Laserfiche WebLink
GNccm � <br /> Burnett'CoUnty Office of Zoning Administrator w Q o <br /> APPLICATION FOR — LAND USE — PERMITS z 3. o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and - c <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur. 3 a <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- <br /> tions of the State of Wisconsin. w <br /> N <br /> Burnett County Hist. Soc. Donald Daniels `m o O <br /> OWNER(Please Print) Forts Folle Avoine Contractor or Surveyor or Agent n : <br /> PO Rox 31 1(10 Johnson St- PO Box 916 m `, <br /> Address Address g, <br /> Siren b!I c;r,an ut7 FllR72 <br /> ts <br /> City,State,Zip Code City,State,Zip Code m <br /> 715-949-2219 715-349-5533 t car <br /> Telephone Telephone <br /> 0 <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving p x <br /> r- <br /> Sanitary — Camping Unit to <br /> Privy Subdivision 0 <br /> Structure Use: C` ," I )1,R�1 DN L7 `a o <br /> 0 0 <br /> (family me/cabin, garage, addition, etc.) Z o <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). N <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, -4 <br /> river or stream, if applicable. 0 H <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. m <br /> a <br /> 0 0 <br /> o - o <br /> 3 - 0 <br /> a - o U <br /> Z <br /> P 7 <br /> S E E S T A T E A P P R O V E D P L A N c w <br /> m to <br /> � c <br /> v <br /> n <br /> N <br /> � 5' z <br /> E <br /> I <br /> oQ w <br /> � N <br /> C m <br /> �c n <br /> O 0 <br /> N � <br /> n N <br /> r <br /> r <br /> I o <br /> m <br /> m <br /> Z <br /> 0 <br /> n Z <br /> s <br /> f <br /> a c - 0 ma m <br /> 0 a`c mna� <br /> a 5 <br /> m i o 0' 3 <br /> Z <br /> ^ [ 2 i m <br /> o[ a <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 r. E [ y. ? m <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we) 0 <br /> further declare that I(we)recognize that this information I(we)am(are)providing will be relied upon by the County of Bur. E Q E <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the a <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 i <br /> SIGN HERE 7/29/89 <br /> V: <br /> ( ' lure of owner r buil 'ng contractor) (date) <br /> C�€ <br /> ZONING ADMINISTRATOR i �-n <br /> N N V <nN m <br /> Mac)TOWNSHIP PERMITS MAY BE REQUIRED ac) 000fA <br />