Laserfiche WebLink
Burnett County Office of Zoning Administrator d M 0 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 nn <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the But- 0 c VvJ <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 : / a v o <br /> 07R�O Prj t) s _ r� Contractor or Surveyor or Agent o <br /> tv <br /> Addr s Address <br /> 7rCi y,State, i Code City,State,Zip Code 1 <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving <br /> Sanitary Camping Unit 0 o <br /> Privy Subdivision o'm <br /> / i` <br /> Structure Use: Ll v )n n Adc�boJ / / �` T <br /> (family home/cabin, garage, ddition etc.) o 0 <br /> a <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). <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. ' <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 /> O <br /> 6, rove a ego description on a side o this form) as on tax statement. <br /> PLOT PLAN <br /> a to <br /> J o n <br /> N 5 <br /> J(G j <br /> (1 1114, r <br /> o <br /> a N <br /> O <br /> m <br /> 0 <br /> > > o <br /> ` . LS) Z <br /> DDW� <br /> 0`> 0i a-- <br /> zyoMCO3 <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m <br /> PP f 9 Y ) Y ll <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all m <br /> information contained in this application(including an accompanyingschedule and I further declare that I recognize that n ' O <br /> PP C 9 Y ) 9 <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a o <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 officials charged with administering county ordinances or other authorized <br /> person to have access to ttae above described Pl ises t any reasonable time for the purpose of inspection. <br /> T <br /> SIGN HERE <br /> (sig re ,f owner�or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> N N O N <br /> TOWNSHIP PERMITS MAY BE REQUIRED ` Nu �� �. m <br /> 0000 o y <br />