Laserfiche WebLink
I <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator -1 0) 71 o <br /> APPLICATION FOR — LAND USE — PERMITS 3 = _ <br /> w 0 <br /> TO THE ,ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m v <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 0 m <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. - o <br /> / w m <br /> N A <br /> C <br /> OWNERa se Pri5y <br /> Afe Contractor or Surveyor or Agent n �� <br /> Adc!27 Address <br /> City,Stile,Zip C qdQ en'n— — City, State,Zip Code <br /> lei <br /> �epL-hyne Telephone <br /> Emergency/FireN�ad Name <br /> Legal Description(as indicated on tax statement) o <br /> Permit(s)Applied for: <br /> 0 <br /> New Building Sanitary Filling/Grading Camping Unit <br /> N <br /> Addition Privy Moving Subdivision o .°r. <br /> � 2�>< r Ort�C/ <br /> Structure Use: o <br /> a <br /> '(family homakabin,garage,addition,etc.) <br /> Directions for plot plan drawing: <br /> L� <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). <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, 0 <br /> river or stream, if applicable. M p� <br /> 5. If,separate plans are submitted by an architect,engineer, builder,contractor,etc.,the plans must be signed and dated by O <br /> 0 <br /> the owner. 0 <br /> 3 <br /> O <br /> PLOT PLAN 1I Z <br /> o a <br /> C <br /> v <br /> H _ <br /> m � <br /> V\ <br /> coe <br /> N <br /> ac <br /> m <br /> o <br /> .nr <br /> Z <br /> I <br /> m cswd�ac�9 <br /> m nc -'am ;nom <br /> c' " o =Q <br /> Z w.E ,2mo �ro _ <br /> G i � O� <br /> mviE [ A <br /> �C O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible forthe detail and accuracy of all informs- <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 <br /> further accept liability which may be a result of the Count of Burnett relying on this information I am providing in this a ` on o <br /> P Y Y Y Y 9 P g P- : o o: <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. O^p <br /> 3 m : <br /> o ; <br /> SIGN HERE (/Cf//�.Ld �L.!(/J//�J�� I <br /> (signat of own uilding contractor) (date) o S <br /> ZONING ADMINISTRATOR �`� '%��Z�II <br /> NNON��fltm <br /> TOWNSHIP ERMITS MAY BE REQUIRED o rn v v o 0 o m <br /> oogggoofA <br />