Laserfiche WebLink
ON COMPUTER/SCANNED 01') CC,IV)f, <br /> Bumett County Office of Zoning Administrator w - o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> ° a s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and '� y u) <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m c y <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. = omrJ <br /> N d <br /> m <br /> IJILKIr �EI�R>tu kOPeRI(k 14OPPIVS a z: o <br /> O-W�N{E�R(Please Print) Contractor or Surveyor or Agent o 0 <br /> Address Add (/1 <br /> 1JEOSTER 01 SIM wf--65TH 431 ryblz I <br /> City,State,Zip Code City,1State,Zip Code F <br /> � .i `Rbb <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading (I <br /> Addition Moving o (1\ <br /> Sanitary Camping Unit o <br /> Privy Subdivision m <br /> r <br /> a o <br /> Structure Use: <br /> (family home/cabin, garage, addition,etc.) 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. <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, Z <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 1 <br /> the owner. <br /> O <br /> 0 <br /> PLOT PLAN 3 <br /> c <br /> Z c <br /> �TTAcNte10 o y <br /> r <br /> w m Z <br /> w � a > <br /> � n <br /> I <br /> o — <br /> ry N� <br /> 0 <br /> 0 C) n <br /> ^ o <br /> o by <br /> 0 0 <br /> y � <br /> t7 <br /> rte <br /> � Z <br /> rcy- <br /> :E <br /> N c M.N 0 0 n a m <br /> n o-< JJOp-.m <br /> m o.� - o•m c;a� <br /> a " cyo'� 3 <br /> N � N O J�O <br /> O U 71 <br /> in[ m <br /> p n : C) <br /> o: <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my S <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 A D <br /> PP (� 9 Y 1 9 ; p i <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 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 /> T <br /> N <br /> _ N <br /> SIGN HERE <br /> (signatur owner or ing contractor) (date) <br /> ZONING ADMINISTRATOR I o o <br /> �T <br /> WNSHIP PERMITS MAY BE REQUIRED 7 N^ c o m <br /> � o 0 000m <br /> 000 000M <br />