Laserfiche WebLink
Burnett County Office of Zoning Administrator co 06 <br /> APPLICATION FOR — LAND USE — PERMITS z <br /> w ° <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m c 00 <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 3 ii (n <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- <br /> y <br /> tiorof9e State of Zisconsin. / /� — <br /> Jo n V /) t4 4-r tits S ill-t5r � + !/ o � <br /> � = (� <br /> OWNER(Please Print ../., Contractor or Surveyor or Agent a £ <br /> i 3 fo 0 1 c 6'r I R E d <br /> Address = o <br /> 18 i� A <br /> City,State,Zip Code City,State,Zip Code A� <br /> Telephone Telephone <br /> K/ r <br /> Permit(s)Applied for. 1 <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit <br /> Privy Subdivision o <br /> y <br /> Structure Use: ° <br /> (family home/cabin, garage, addition, etc.) z o <br /> O 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 t <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, N <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 /> A <br /> O f� <br /> O <br /> fes- 3 r <br /> v o <br /> 2 <br /> l <br /> %J <br /> Or <br /> � � n <br /> 0 <br /> m <br /> n ° <br /> IC/ � o <br /> Z <br /> �o <br /> M y rDD C3'D <br /> n a> moacm <br /> om= <br /> ° <br /> m a as a� <br /> N [ N ° ° ° <br /> O > N: <br /> m <br /> o c C <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of 0 <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 /> Bur- <br /> further declare that I(we)recognize that this information I(we)am(are)providing will be relied upon by the County of Bur- <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- <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 /> ° <br /> SIGN HERE /'e✓G"-�-U ` '. E E E N <br /> (si at of woes or buildi tractora (date) <br /> o: $ <br /> • li E <br /> ZONING ADMINISTRATOR _ N o N T <br /> OWNSHIP PERMITS MAY BE REQUIRED o 0 000vmi <br />