Laserfiche WebLink
Burnett County Office of Zoning Administrator ; m F 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3 <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 n <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. <br /> N � <br /> SP1 <br /> m <br /> OWNER(PI srintY! 0 � <br /> 0Yo^ Contractor or Surveyor or Agent n F <br /> I / obi 1 'mom <br /> Addresses�` Address `3 O <br /> City,State,Zip Code City,State,Zip Code <br /> c7ftery T <br /> Telephone 317_ 591Telephone <br /> Permit(s)Applied for: v <br /> New Building Filling/Grading <br /> Addition Moving O <br /> Sanitary Camping Unit O <br /> Privy Subdivision o Z <br /> w <br /> Structure Use: & OA <br /> (family home/cabin, garage, addition,etc.) z <br /> P ° <br /> a <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). /,i <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. 06 <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and dal d by 2 7 <br /> the owner. <br /> 0 /n <br /> o F V� <br /> z <br /> 0 <br /> 0 4 r <br /> in <br /> Q <br /> 0j P I n <br /> ��' <br /> � w <br /> Z <br /> 0 <br /> m <br /> 0 0 <br /> w � <br /> 2. <br /> 1 <br /> m W <br /> a 4 <br /> Z <br /> O <br /> 2 <br /> 9 <br /> 1 <br /> m c�wm�n m <br /> w W w p = 3 <br /> Zof <br /> o rn: r0 <br /> m <br /> c <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best k <br /> m <br /> my(our) knowledge and belief it is true,correct and complete. I (we)acknowledge that I (we)am(are) responsible for t e m <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (w ) O <br /> further declare that I(we)recognize that this information I(we)am(are)providing will be relied upon by the County of BL r- <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of If e <br /> County of Burnett relying on this information I(we)am(are)providing in this application.I(we)agree to permit county of i- <br /> cials charged with administering county ordinances or other authorized person to have access to the above described pr - <br /> mises at any reasonable time for the purpose of inspection. i <br /> m <br /> SIGN HERE <br /> (si r of owner or buil contractor) (date) <br /> o; o <br /> ZONING ADMINISTRATOR -I <br /> m <br /> NNOIJ+ m <br /> TOWNSHIP PERMIT AY BE REQUIRED 00008 Vi <br />