Laserfiche WebLink
Burnett County Office of Zoning Administrator 00 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and � y (� <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula. 3 n <br /> tions of the State of Wisconsin. o �' <br /> &Jr/ ,L�i�rnvr� Sel n = o <br /> OWNER(P,leasn/ <br /> e P int) Contractor or Surveyor or Agent o . <br /> �P3rc�' S�ieef 2 <br /> m <br /> Address Address <br /> City,S,4ate� Code <br /> J�— City,State,Zip Code <br /> Telephone Telephone <br /> Permits)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit o <br /> Privy Subdivision 0 .C. <br /> /wt//(9�� D�� N 0 <br /> Structure Use: //�U ° <br /> (family hom (cabin, garage,addition,etc.) o 0 <br /> m <br /> Directions for plot plan drawing: 7L <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NS)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 /> O <br /> LO �Ak, a legal description on the side of thisform) as on tax statement. <br /> 3 <br /> a m <br /> C <br /> Z �` a <br /> N <br /> O <br /> 1 J <br /> 1 0 <br /> 4 <br /> 311 (01 <br /> > <br /> fVr-f <br /> 0 <br /> i J <br /> N <br /> O <br /> J 1 <br /> J <br /> m <br /> O <br /> �rr <br /> 73 Z 0 <br /> O <br /> Z <br /> o J n <br /> LD. m - <br /> < w 00 <br /> 4 O J <br /> Z 1� : <br /> O rn: <br /> m <br /> f o [ O <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m o c C <br /> PP (� 9 Y ) Y ll ; m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all f m <br /> PP (including Yaccompanying ) g n <br /> information contained in this application includin an schedule and I further declare that I recognize that � a ; p <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether tc issue a o <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing N <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 /> T <br /> N <br /> N <br /> SIGN HERE � _ <br /> (si atu of o�or building contractor) ( ate) o o <br /> U . <br /> ZONING ADMINISTRATOR <br /> w� <br /> TOWNSHIP PERMITS MAY BE REQUIRED N m <br /> 0 0000fn <br /> i <br />