Laserfiche WebLink
Burnett County Office of Zoning Administrator m 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3_ <br /> d o <br /> TO THEZONING 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 a <br /> do s of the State of Wisconsin. m o <br /> OWNER(Please Print) Contractor or Surveyor or Agent o <br /> �a <br /> Addres Address <br /> �f 71u} a <br /> City,State,Zip Code City,State,Zip Code JIC <br /> 1 A <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving C' <br /> Sanitary — Camping Unit o <br /> Privy Subdivision m <br /> 0 <br /> Structure Use: <br /> (fa ly home/cabin,garage,addition, etc.) o 4- <br /> Directions <br /> v 4- <br /> m <br /> Directions for plot plan drawing: <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North (N). <br /> 2. Show the location of the well (W) septic tank(ST), and drainfield(DF). r <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. U o <br /> lake <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 , <br /> river or stream, if applicable. 0 <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 /> a statement o <br /> PLOT PLAN 3 u! <br /> C <br /> Z o <br /> 0 a <br /> 45. <br /> 02. <br /> 0 <br /> I � o <br /> 0 <br /> o � <br /> 0 <br /> N � <br /> O <br /> ZN <br /> Z <br /> O <br /> -eZ <br /> I � <br /> 6 <br /> 40�i <br /> cpmcDi Da to <br /> m n� 0 0aa� <br /> m <br /> O 7 O <br /> N <br /> OZ O `z � <br /> � U1: <br /> U ^ 2 m <br /> v n : D <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> -o <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all m <br /> A <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that <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 <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 /> T <br /> ggN <br /> A <br /> SIGN HERE <br /> lsigiature of owner b 'di g contractor) (date) <br /> o: <br /> ZONING ADMINISTRATOR ' o o <br /> aONL e m <br /> m <br /> N �N <br /> TOWNSHIP PERMITS MAY BE REQUIRED u p o m <br /> $oo6000YA <br />