Laserfiche WebLink
Burnett County Office of Zoning Administrator ; -0 o o <br /> APPLICATION FOR - LAND USE - PERMITS 3 <br /> z <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and v m <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 3 Co <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. f /l O 1 m o <br /> cN 5 / 1 C' Aj <br /> OWNER y <br /> Please Print / n <br /> ( ) Contractor or Surveyor or Agent f <br /> �T6 �1_?ha lav P� -� �Gk MRSA e <br /> m <br /> Address // Addre/ss / r !_ m <br /> y7n J'�ti Z&O r !�¢p <br /> City,State,Zilfe Cfrode //. 117 City,State,Zip Code�,(I�Y� S�c fz. C-CJ1 SC_ Q $largo -9, 3 A <br /> Telephone 8�,(p — 78� � 1803�^1�erI�eJ21�e1 hone 7 <br /> Permits)Applied for: , rn N �� <br /> New Building Filling/Grading <br /> Addition Moving <br /> 0 <br /> Sanitary Camping Unit m' <br /> n <br /> Privy Subdivision o <br /> _ <br /> /1 w <br /> Structure Use: 2 <br /> (family home/cabin, garage, addition, etc.) Z <br /> o ° <br /> a <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). _4 <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. r <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 /> n <br /> 3 <br /> J'-' <br /> —�l-- / 3 r <br /> �lokrJSc,AJ G. k1 k ° <br /> `4„ N <br /> Q <br /> a <br /> 5 <br /> 01 <br /> OP <br /> C+' <br /> _ <br /> 1 0 <br /> - Z <br /> a <br /> �fI� 9� ° <br /> r <br /> Q uPeU 1 M U)M co r> <br /> ° >>M <br /> m v- mon-m <br /> am =ELM <br /> —'O <br /> ._ AcCG.sSoaA — n[ € 2 m <br /> I(we)declare that this applicatio i(including any accompanying schedule)has been examined t y me(us)and to the best of o C <br /> my(our) knowledge and belief it is true, correct and complete. I (we)acknowledge that I (we) m(are) responsible for the — M <br /> detail and accuracy of all Information contained in this application (including any accompa ying schedule) and I (we) �` O <br /> further declare that I(we)recognize that this information I(we)am(are)providing will be relied jpon by the County of Bur- <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability wl ich may be a result of the [ `:o`: [ <br /> County of Burnett relying on thiE 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 purpose of inspection. <br /> SIGN HERE • 7— /9--p ,7 �° ' d+ <br /> (si ture of owner or building contractor) (date) <br /> o' <br /> /f_ <br /> ZONING ADMINISTRATOR �� i <br /> u NNfOTNO (NTT <br /> TOWNSHIP PERMITS MAY BE REQUIRED SSSSS S <br />