Laserfiche WebLink
5) ��Mp. <br /> Burnett County Office of Zoning Administrator co T f o <br /> -APPLICATION FOR — LAND USE — PERMITS <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- <br /> 3 nCD <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- <br /> tions of the State of Wisconsin. �, m <br /> MAK <br /> OWNER(Please Print)' Contractor or "APION n b` F <br /> �G/LL3 �/uLl H't'tty� �• n oOi m <br /> Address 59' b�rif m <br /> pro a� S <br /> WWI rF�a 5f Address MM SAoater, wl 5�f t1 <br /> City,State,Zip Code City,State,Zip Cod L <br /> c3noonw LAL); 5 { &DI <br /> Telephonb Telephone ) <br /> Permit(s)Applied for: / <br /> New Building Filling/Grading l <br /> A Moving r <br /> �a— o � <br /> Sanita �_ �A« Camping Unit <br /> Subdivision o <br /> N <br /> Structure Use: o <br /> (family home/cabin, garage,addition,etc.) z v <br /> 0 0 <br /> a <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. _ 1r <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. O <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 /> O <br /> a o <br /> /^ ^ Z <br /> 9 <br /> 9 <br /> W 0 <br /> N <br /> 1 w <br /> N <br /> 0 m <br /> � . m <br /> m <br /> R Q- o <br /> 1 0 <br /> ^ � I <br /> Zz <br /> o Z <br /> mn <br /> >>Oo y <br /> m n m <br /> m a m ,:nA <br /> o <br /> m <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of 30my(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) <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 b' <br /> County of Burnett relying on this information I(we)am(are)providing in this application.I(we)agree to permit county offi- ` pf <br /> cials charged with administering county or inances or other authorized person to have access to the above described pre- <br /> mises at any reaso able time for the pur se of inspection. <br /> SIGN HERE �)<�` 'L <br /> (sNgnat4e of wrier or it i c ctor) (date) ; ' c <br /> ZONING ADMINISTRATOR - `»-7 <br /> f WtT fT (TOON <br /> TOWNSH PERMITS MAY BE REQUIRED o8 0000N <br />