Laserfiche WebLink
C( <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d 0 o a <br /> APPLICATION FOR - LAND USE - PERMITS3. ' - <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v N <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 0. <br /> regulations/of the State of Wisconsin. H m <br /> f <br /> O)NN— R�ease Print Contractor or Surveyor or Agent o 'p <br /> Addre Address I <br /> City, State, Zi de / City, State,Zip Code 0 <br /> Telephone Telephone �� J <br /> EmeSgiten/cy� AN17 / pSa ea3 4/yt/ V <br /> LZ71XZ D <br /> Legal Description (as Indicated on tax statement) <br /> O O� 1 <br /> Permit(s)Applied for: o � 3 <br /> w r <br /> Dwelling Addition Filling/Grading Camping Unit � o <br /> v <br /> ZVM0 'o <br /> Accessory Building Sanitary Privy S bdivision Garage <br /> StructureUse: 67hr to <br /> (amity home/ in, garage, ditio etc.)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). O <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). C 3 <br /> 3. Show the location of any lake or flowage-if within 1000 ft. and the location of any river or stream- if within D c <br /> 300 ft. o n <br /> 4. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building m w <br /> to 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 w <br /> dated by the owner. <br /> of <br /> L <br /> PLOT PLAN <br /> E <br /> 0 <br /> w m <br /> l � <br /> J <br /> N <br /> o <br /> O <br /> M <br /> I �_ <br /> a <br /> < m o 0 �' 3 <br /> 2 m o A Z M <br /> O f T In <br /> In <br /> g ' ` m � <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m 3I m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 75 0 N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 m 8 <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- Wi <br /> N <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have u, o , <br /> access to the above described premises at any reasonable time for the purpose of inspection. m W g x [ <br /> m m AA <br /> H u8 = <br /> SIGN HERE Le�� <br /> (signpJ.ure of owner or building co ra o (date) o x <br /> ZONING ADMINISTRATOR - <br /> s 2z s <br /> MAY BE REQUIREDTOWNSHIP PERMIT NU <br /> m <br /> 888N <br /> 8888rmn <br />