Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator to _0 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> » <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- <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- <br /> tions f he State of Wisconsiin/ / o <br /> Llr N e s <br /> o <br /> OWNER(Paease�t) Contractor or Surveyor or Agent <br /> /'C a d • f <br /> /J AV <br /> 01 m <br /> Ad s T Address <br /> �Q J I <br /> City, <br /> ,SState,Zip Code��// e7 's 7tre City, State,Zip Code t <br /> ii`2-11-11�L j5 <br /> Telephone Telephone lk <br /> Emergency/Fire Ny. and[,jjd plame <br /> Legal Description (as indicated on tax statement) '1 <br /> Permit(s)Applied for: o o .S <br /> New Building Sanitary Filling/Grading Camping Unit <br /> Addition - -�� Priv Moving y/— Subdivision 71o <br /> Structure Use: t Y��,U �IA�( `-' o ° <br /> (family home/cabin, garage, type of add tion, etc.) _ <br /> � r <br /> Directions for plot plan drawing: n <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North(N). S+� <br /> 2.Show the location of the well (W), septic tank(ST), and drainfield (DF). V1 0 <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, b 'Ide[.l ntracfor,etc.,the ans must be signed and dated by <br /> the owner. TT!! dfJ o <br /> 3 <br /> PLOT PLAN p m <br /> Z c <br /> ° a <br /> rn <br /> O <br /> /1 d.i,r�Pl r <br /> » <br /> %�l oll I 0 ' 1 <br /> I = 1 <br /> 1 <br /> S61B0cKs G� <br /> Porc� t <br /> J <br /> lot <br /> N c d ° 6c <br /> o0m <br /> --- <br /> _ M <br /> m <br /> o: <br /> I declare that this application((i cluding any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,corrA t and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- o : in <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. I o <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. <br /> SIGN HERE � ' <br /> (signature of owner or building contractor) <br /> ZONING ADMINI T ATOR ITOMM <br /> o: o <br /> o: o <br /> w In <br /> �cNi��NootNi� m <br /> TOWNSHIP PERMITS MAY BE REQUIRE off <br /> I o 0 0 0$o o fm/1 <br />