Laserfiche WebLink
Burnett County Office of Zoning Administrator d - o 0 <br /> APPLICATION FOR — LAND USE — PERMITS _ <br /> o s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m J) <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- T c <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 a <br /> tions of the State of Wisconsin. <br /> N <br /> L S a ll'( o <br /> OWNER(Please Pri _ Contractor or Surveyor or Agent <br /> �7L�i lCytee S 1) hJ - P-1 -"f S`L �i — <br /> Address <br /> lab tv it/ <br /> City,State,Zi Co - City,State,Zip Code <br /> Telephone Telephone t� <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving <br /> Sanitary Camping Unit a o <br /> Privy Subdivision <br /> � 1 r <br /> Structure Use: San- '�"" � I La 4v <br /> orn <br /> (f ily home/cabin,garage, addition, etc.) Z <br /> 0 <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). ii0 <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. <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. r�) <br /> 5. If,separate plans are submitted by an architect,engineer, builder,contractor,etc.,the plans must be signed and dated by r\ <br /> the owner. o rK <br /> PLOT PLAN a ega escrip ion on a ide of this form as on tax statement. 3 [1'Ia <br /> c <br /> Z a <br /> o n <br /> ��lulA�7E 3. <br /> 0 <br /> � � T <br /> � 7) n <br /> D GC� G0 G <br /> 0 a , . � AUG 2 3 <br /> CKS[`)�t <br /> n <br /> O <br /> : <br /> l l 0`n m <br /> -5 <br /> [ 4 <br /> (moo: c'. � C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o <br /> knowledge and belief it is true,correct and complete.I acknowledge that lam responsible for the detail and accuracy of all A m <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 oo <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing �� a <br /> in this application. I agree to permit county officia arged with administering county ordinances or other authorized <br /> person to have access to thea a desc 'bed pr i sat any reasonable time for the purpose of inspection. <br /> T <br /> N <br /> (D <br /> SIGN HERE <br /> gna re of er ilding contractor)_ (date) <br /> ZONING ADMINISTRATOR <br /> `i -n <br /> IJNOiJ� +Nm <br /> TOWNSHIP PER ITS MAY BE REQUIRED m <br /> 00000gofA <br /> �,�, S � o r�rec�s act✓rL (' <br />