Laserfiche WebLink
C-7/\. <br /> Burnett County Office of Zoning Administrator w M o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> z s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m c <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 3 mQ <br /> nett County Lad Use Ordinance,Sanitation Code,and wjth la�other appli atjlgCyunty Ordinances and the laws and regula- <br /> tions of the Stat of i onsin. lj fU�e_�1 V.�1 l f� C <br /> nee V�� = o <br /> OWNER PI aseP t) Cont ctdrorS ygcW n <br /> a�s�3 ��. /.� • A �I I tIV l a' <br /> Address Address�� g <br /> City, ate,Z' ods, City,State,Zip Code 1 <br /> poi 79- �9 <br /> Teleph0 Telephone <br /> Permit(s)Applied for: CQ <br /> New Building Filling/Grading <br /> Addition Moving p <br /> Sanitary Camping Unit <br /> Privy Subdivision 0 <br /> Structure Use: SIV I fel �"L"r o <br /> v <br /> �— (family omelcabin, garage, addition,etc.) o a <br /> 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. <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. •�1� n <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 /> 0 <br /> 3 r <br /> o o <br /> Z Y <br /> I <br /> N <br /> c <br /> n <br /> K 5 <br /> tV w <br /> a o <br /> ( N ro O 0 <br /> V O O <br /> w � � <br /> W <br /> IfI1 <br /> I I <br /> Z <br /> O <br /> Z <br /> p <br /> I� <br /> m C]mm�acs� <br /> m a� 3nm aa� <br /> m'E Qwp �m3 <br /> m <br /> � <br /> M <br /> Cc t p <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. 1(we)acknowledge that I(we)am(are)responsible for the ,:? E m <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we) C <br /> further declare that I(we)recognize that this information I(we)am(are)providing will be relied upon by the County of Bur- b? <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- i i Z. <br /> mises at any reasonable time for the purpose of inspection. <br /> SIGN HERE 9-9-V ' o <br /> (si a re of owner ilding contractor) (date) <br /> ZONING ADMINISTRATOR N N N o o rr m <br /> TOWNSHIP PER ITS MAY BE REQUIRED o$o 0 0 0 8 vmi <br />