Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d o 0 <br /> - APPLICATION FOR — LAND USE — PERMITS3. <br /> 0 O <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and n <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m OC <br /> Burnett County Land Use Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and 3 n <br /> regulglions of the State of Wisconsin. y <br /> OWNER (Please Print) Contractor or Surveyor or Agent o <br /> Pf ,,"Please <br /> Ga u� .6Y.S.P 1600_ <br /> Addr ss Address <br /> ddS'd!Z /iii . _V471 G <br /> City, State, Zip C de City, State, Zip Code QS <br /> 7X.r-3e4- 46 as9 <br /> Telephone Telephone <br /> ��,d,�rr.ev <br /> EmeoT rgency/Fire No. and Road Name <br /> LsEc . 3o Tsid —�PiSuJ <br /> Legal Description (as Indicated on tax statement) q <br /> 0 <br /> Permit(s)Applied for: o °< <br /> r <br /> Dwelling Addition Filling/Grading Camping Unit ° <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision o <br /> Garage <br /> Structure Use: OrQ T f0DVS',6 n r <br /> (family home/cabin, garage, addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: 0 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). 31 0 <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 P <br /> 300 ft. an z <br /> 4. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road, (c)building <br /> to lake, river or stream, if applicable. m o �- <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C I <br /> dated by the owner. m <br /> PLOT PLAN N <br /> p6 6-2- c) <br /> N I u <br /> N p % o <br /> E E -7R <br /> N .� a. <br /> psr <br /> Z <br /> ( <br /> D 0 <br /> m o <br /> ]J a N <br /> G) S 0 <br /> $ ae : c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m `� a <br /> m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the 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. ro N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8A 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- N <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have v, <br /> access to the above des ibed premises at any reasonable time for the purpose of inspection. 8 <br /> m ` N <br /> N N A <br /> SIGN HER _ :��� <br /> (signatureownerroor building con/t�r�ac�tor) (date) <br /> ZONING ADMINISTRATOR t OffiP ) <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N N N N o o 9 In <br /> 88888888 vi <br />