Laserfiche WebLink
} <br /> Burnett County Office of Zoning Administrator d 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> 0 <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- m <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 n <br /> tions of the State of Wisconsin. o <br /> n 0 <br /> OWNS (P.Veasq,{,P�r/int) Contractor or Surveyor or AgentCD <br /> o J <br /> Ad dre s Address l ' <br /> !xk, Park. rn�l s 7 <br /> City, tate, ip C/od�7e/} City, State,Zip Code <br /> / - <br /> �) (Y/�/— a//--r�/ ` 1 <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading J <br /> Addition T Moving o <br /> Sanitary ✓ Camping Unit 0 0 <br /> 0 <br /> Privy Subdivision ,<.- <br /> �' r <br /> 8z 961�I <br /> Structure Use: C1961d, <br /> (family home/cabin, gar ge,addition,etc.) o v° <br /> _ m <br /> Directions for plot plan drawing: nn '' <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North(N). w <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 /> 6• a Or tnis form s a emen . o <br /> PLOT PLAN 3 <br /> 3 N <br /> Z v <br /> �xpi r 0 <br /> 2 �K4 m <br /> PeRmi VJ <br /> rn <br /> O <br /> -1 <br /> T <br /> N <br /> O <br /> 2 <br /> 9 N N D06.1 <br /> LDa � <br /> 9 < d y <br /> N O <br /> Z O E .. `2 <br /> O ] : <br /> o D <br /> o c C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all n 1 <br /> PP (including Yaccompanying ) recognizeAli A <br /> information contained in this application includin an schedule and I further declare that I that a : p <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a c <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing u, <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> D <br /> N <br /> SIGN HERE <br /> (si nre f owner or ding contractor) (date) o o <br /> ZONING ADMINISTRATOR <br /> o: o <br /> m <br /> TOWNSHIP PERMITS MAY BE REQUIRED VNON+�N <br /> O�O�N(TOON <br /> 0000000th <br />