Laserfiche WebLink
Burnett Cbun'ty Office of Zoning Administrator ; m £ 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3' <br /> z g <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes applica ''pa-f the work described and o w <br /> located as shown herein.The undersigned agrees that all work shall be dc n accordance dance wiitRh the r irements of the Bur- <br /> nett County Land Use Ordinance,Sanitation Code,and with all other licable County Ordinances and laws and regula- <br /> tions of the State of Wisconsin. m m <br /> ('_W JQ PLE_S F / SEL <br /> OWNER(Please Print) Contr or Survoor o F <br /> Address Add s <br /> PlagfgJV)EW, M(0 . 5s9b4 <br /> City,State,Zip Code City, <br /> cr9 '7- sc� ' ZZ � 9 . ; <br /> Telephone Tele � •t � � C <br /> r� <br /> Permit(s)Applied for: - <br /> �' <br /> New Building _� FillinglGradi (� <br /> Addition Moving 00 o <br /> Sanitary C <br /> Privy Subdivision U1 W o <br /> Structure use: T Ff4VN%L V C'A% I tJ Q T' a <br /> (family hometcabin,garage,addition,etc.) z o ( \ <br /> O U <br /> N <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. J <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 /> o <br /> w � AIM <br /> s � <br /> s a' 4i6 <br /> yoirrll Cn <br /> �: v� ���• gruND�y m =' <br /> ta <br /> 21 <br /> s,T. > <br /> UP z p <br /> o r r, 1 0 <br /> i <br /> r2M 07 fi° IA <br /> 3 10 <br /> 0 <br /> m a m n <br /> o � <br /> FlSf/ 6AK2 m <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of S; m <br /> my(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- ?F <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 count <br /> offi- <br /> cials •� <br /> charged with administering county ordinances or other authorized person to have access to the above described pre- ` `N'• <br /> m O: <br /> mises at any reasonable time for the purpose of inspection. m <br /> SIGN HERE F=;:s=k ID— 4I' <br /> (sig re of owner o wilding contractor) (date) <br /> - g <br /> ZONING ADMINISTRATOR l <br /> ml N N O N <br /> OWNSHIP PERMITS MAY BE REQUIRED o8 0 <br />