Laserfiche WebLink
i <br /> Burnett County Office of Zoning Administrator co m $ o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m 00 <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- <br /> tions cf�he State of Wisconsin. <br /> J� m 01 <br /> 61I f") {�L-�t L = m <br /> m <br /> OWNFP(PI ase Print) Contractor or Surveyor or Agent f <br /> m m <br /> Address Address g <br /> City,State,Zip Code City,State,Zip Code <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition - Moving O <br /> Sanitary Camping Unit <br /> Privy Subdivision o <br /> � <br /> Structure Use: Ile)/e) 1�, — xt'i N7 hs ZA VR, - F"Aps'a IU I��g,-6 12 0 <br /> (family home/cabin, arage,addition, etc.) z o <br /> 0 v <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 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 /> ,5C <br /> 0 <br /> m <br /> OKI <br /> fkelcue *c� Z <br /> S �yt6 60`V r6[ k 6t jf— pr,d0 _[O 141 I m <br /> a <br /> AI?LI[: NE�� pot--,- <br /> 1 otic- B � o <br /> _ it <br /> 2. <br /> [ <br /> � o 0 <br /> Alf <br /> C <br /> ttr,s I �I 0610 <br /> �L 1A <br /> �— r�e� d <br /> F. - <br /> �`/ Z _ <br /> \ ;f I 157;:' ���Mf <br /> I rl-l?A-f <br /> sif•otS.`` aam <br /> r o 6'53 <br /> So Ib b 9�f � ) 6 c it 04-e Z m:? z00 <br /> �►// SM...� s�lzF�esa.� �' ' l�fr`y -6-7�.t� eye 1'h <br /> c i m <br /> — — '0 o <br /> w� € = <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 m <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we) O <br /> further declare that I(we)recognize that this information I(we)am(are)providing will be relied upon by the County of Bur- r <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the <br /> County of Burnett relying on this information I(we)am(are)providing in this application.I(we)agree to permit county offi- imi <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 /> SIGN HERE <br /> (si ure of <br /> ownerpybuilding contractor) (date) ? o? ? o <br /> o: o <br /> ZONING ADMINIS ATOR ` vi-I <br /> N N O V N m <br /> U1 U•Ut N O N <br /> TOWNSHIP PEll MAY BE REQUIRED o000 oInn <br />