Laserfiche WebLink
Burnett-County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d 5 0 0 <br /> APPLICATION FOR - LAND USE = PERMITS 3 <br /> 0 <br /> z rn <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- n <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 Wisconsin. m m <br /> �l N 1 � � �aB6lG�JSrit� dxJST a o <br /> OW/}P,lease Pri ) �� Contractor or Surveyor or Agent <br /> Address Address <br /> City,State,Zip Codgg� City,State,Zip Code <br /> 707 <br /> Telephone Telephone <br /> to d <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as indicated on tax statement) <br /> Permit(s)Applied for: 0 <br /> 0 <br /> w <br /> New Building Sanitary FillinglGrading Camping Unit ^`c <br /> Addition � Privy Moving Subdivision o <br /> �) Z o <br /> 3 <br /> Structure Use: ° <br /> (family home abi , garage,type of dditi etc.) `D <br /> Directions for plot plan dr g: <br /> 1. Show the location an iz f all existing buildings(EB)and all new buildings(NB)and indicate North (N). <br /> 2.Show the location oft ell IN, septic tank(ST),and drainfield(DF). .°r. <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 ordi- <br /> nary high water mark of lake, 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 0 <br /> the owner. <br /> 3 <br /> 9 <br /> PLOT PLAN Z c <br /> o Q <br /> Rj <br /> n <br /> 1 <br /> 0 <br /> i <br /> EB � to <br /> � <br /> C <br /> TVa1 <br /> J.t = <br /> oil <br /> I ,r Ng ICI <br /> 1 t 41 <br /> z <br /> f'J D <br /> --- <br /> CI <br /> See San• ��yrmrr- 1�168� ---------- N <br /> m <br /> ,Saw{ <br /> o : c <br /> I declare that this application(including any accompanying Schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- bo o G <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 a <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap. <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m <br /> SIGN HERE <br /> (sig ture f owner il�ding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> T <br /> TOWNSHIP P RMITS MAY BE REQUIRED 6 0 <br /> m <br /> 0000 <br /> 00000 <br /> CA <br />