Laserfiche WebLink
Burnett County Office of Zoning Administrator m0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m U <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m m <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 <br /> tions of the State of Wi-scconsin. <br /> o <br /> a <br /> OWNER(Please Print) Contractor or Surveyor or Agent <br /> v N <br /> `��11�1�'%nirJFJF��� <br /> Address Address <br /> City,State,Zip Code City,State,Zip Code <br /> Telephone Telephone <br /> Permit(s)Applied for: t <br /> New Building Filling/Grading <br /> Addition Moving 4 <br /> Sanitary Camping Unit o N <br /> Privy 1 Subdivision m V <br /> 0 <br /> On It ° <br /> Structure Use: N; 7)2� <br /> (family homelcabin,garage,addition, etc.) Zo o � <br /> c <br /> m J <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). m <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 /> n <br /> rove a legal description on the side of this orm as on tax statement. O <br /> PLOT PLAN <br /> P m <br /> Z <br /> o a n <br /> m <br /> o (1 <br /> yJ <br /> cA <br /> (iC <br /> G rn <br /> o <br /> U � <br /> N � <br /> 0 ti <br /> 0 0 5 <br /> T <br /> Z <br /> O <br /> Z <br /> D <br /> In <br /> r•DD to-0 <br /> m c m0oacm <br /> n a c a— <br /> m a� - m n a <br /> d <br /> c m' o0m3 <br /> 0 <br /> Ni i 31 <br /> m <br /> cccii 0 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my no m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all In <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 <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing I y <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized n <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> _ m <br /> SIGN HERE <br /> (Iss�'l��f to re of ownerro�r i Ing co ttractor) (date) '. �': [ N <br /> ZONING ADMINISTRATOR <br /> v IVNOIJ:+�Nm <br /> �j TOWNSHIP PERMITS MAY BE REQUIRED o'ao 0 0 0 0 o m <br /> 0000000W <br />