Laserfiche WebLink
C,3 J'\ ('c-. V ) ) <br /> Burnett County Office of Zoning Administrator w 0 o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> w o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m l <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m Lj V <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. <br /> /419& o o <br /> OWNER(Please Print) Contractor or Surveyor or Agent o <br /> Address a Address <br /> City, State,Zip docle /y�JOJ City,State,Zip Code .1 <br /> Telephone 76 3 9 c�?l Telephone <br /> f <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition 4!00� Moving O ' <br /> Sanitary Camping Unit o <br /> Privy Subdivision m <br /> 11� { / r <br /> Structure Use: "f� on l i�� O..)11�/� �Cx ��&11 v o <br /> (family home/cabin, garage, addition,etc.) o o° <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 /> Eo i e legal description on a side o is orm as on ax 3 <br /> LO �LA�J <br /> ,Lor hl Sr C, a 2 Tui 40 NO2 Or Z <br /> o a <br /> �� �ti ✓GE /� �Fsr jju2N�rr dry /l/is� . 9 <br /> LA/Ce /✓ �6°36 3° <br /> _ f• ) <br /> lb <br /> r R <br /> o <br /> A^ 7�l aPOSt a AODiryDl✓ ° <br /> pC <br /> 6 OF 14 <br /> Jw EQdiPhiewr- <br /> cuf.Y�D41 H � <br /> TOOGy, <br /> dao.oo ' C <br /> Alec L z <br /> ,AG <br /> i 75 l; n M Ny ✓ <br /> =0 0 DWS <br /> m a.< a arn <br /> LD. <br /> < ; 2w 3_ <br /> N <br /> O <br /> N: A <br /> m <br /> A <br /> o c C <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 7i A m <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that <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 acces the above described pr mises at any reasonable time for the purpose of inspection. <br /> T <br /> N <br /> SIGN HERE <br /> (si atur of own or buildi g ntractor) (date) i <br /> o: o <br /> ZONING ADMINISTRATOR o' $ <br /> T <br /> TOWNSHIP PERMITS M BE REQUIRED �ooN. m <br /> $oog�l rn <br />