Laserfiche WebLink
Burnett County Office of Zoning Administrator w � o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> 0 o <br /> TO YHE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 'z m <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- <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. 67 <br /> p V� <br /> OWNER Please Print) Contractor or Surveyor or Agent n <br /> � s ('0, Z <br /> Address ` tbb <br /> Ad I-r " <br /> D� r10 <br /> Lhu /��il-P_. _7 �1 s10 l)l Cb <br /> City,State, r <br /> y Zip ode City,State,Zip Code <br /> Telephone Telephone <br /> Permit(s)Applied for. <br /> New Building Filling/Grading <br /> Addition Moving or <br /> Sanitary Camping Unit n M <br /> 0 <br /> Privy Subdivision 0 1`. <br /> w r <br /> Structure Use: <br /> (family hometcabin,garage, addition,etc.) o 0 <br /> w <br /> Directions for plot plan drawing: .7L <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 drainfieid (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 /> n <br /> 0 <br /> PLOT PLAN 3 <br /> a y <br /> Z a <br /> `l o n <br /> t <br /> 0 <br /> 0 <br /> N <br /> 0 <br /> w � <br /> n <br /> Z 0 <br /> O <br /> Z <br /> D <br /> I <br /> 7J rnv(nr > <br /> MI <br /> m <br /> � H 3 <br /> o <br /> m <br /> m <br /> )J n: n O <br /> moo: 0 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 n 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 : O <br /> �v <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to 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 bjj <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized a <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> SIGN HERF� <br /> (sign o wner b di contractor) (date) [ `: <br /> o: o <br /> ZONING ADMINISTRATOR o b: : o <br /> o: o <br /> T <br /> TOWNSHIP PERMITS MAY BE REQUIRED N J m <br /> 0000 o m <br /> 0 0 0 0 o N <br />