Laserfiche WebLink
Burnett County Office of Zoning Administrator 00 a <br /> APPLICATION FOR - LAND USE - PERMITS3 <br /> N O <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m c <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 n !� <br /> tions of the State of Wisconsin. T <br /> i o <br /> �lfl 1 u�3�Y1"12 t�j "{' <br /> OWNER(Pte se Print), Contractor or Surveyor or Agent <br /> ��1� <br /> App��resgg — Hn Addre s <br /> City,State,Zip Code City,State,Zip Code' 4 1 7 <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit m o <br /> Privy Subdivision m »' <br /> Structure Use: <br /> (family home/cabin,garage, addition, etc.) o o <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. r� <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 /> 6. Provide legal descrIption (on the slue or is o as on Eax s a e o <br /> 0 <br /> PLOT PLAN3 m I <br /> c <br /> Z c <br /> ;I o a <br /> F <br /> l.N N_ <br /> �j )cam O <br /> (P_ <br /> a <br /> V) <br /> c <br /> 0 <br /> -'--_N oR. <br /> k <br /> 3tor � <br /> m� <br /> Z <br /> ,' <br /> J Z <br /> D <br /> ✓/- V mC". m;E 0 ori o D,-m <br /> m a� am np <br /> N <br /> OZ O <br /> : 31 <br /> Z,i m <br /> Um <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all ry= : m <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that <br /> a O <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 in <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> m <br /> SIGN HERE <br /> (sfgnat�u re of owner orl.}uilding contractor) (date) <br /> � o o <br /> ZONING ADMINISTRATOR <br /> OWNSHIP PERMITS MA� BE REQUIRED NNON m <br /> nvvcn o <br /> 000b o <br /> 0000 o fp <br />