Laserfiche WebLink
Burnett County 7410 Co. Rd. K, #102, Siren, NI 54872 Office of Zoning Administrator U m O o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and u, <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 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. <br /> N <br /> �� <br /> n O <br /> z <br /> 0 NEfD,(PI a Print)� ac Contrr or Surveyor or Agent o <br /> d J)X At ekR/50/7, PTI )?e <br /> �� / <br /> Ad ess Ad ess <br /> City,State,Zip Code City,State,Zip Code i <br /> his Gv ss�r� •O <br /> Telephone Telephone t (a <br /> Permit(s)Applied for: <br /> New Buildingy Filling/Grading <br /> Addition Moving v <br /> Sanitary Camping Unit n o <br /> Privy Subdivision 0 <br /> m � <br /> Structure use: <br /> (family homelcabin,garage,addition,etc.) o v° <br /> m <br /> 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). <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. 0 <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, <br /> 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 <br /> the owner. 6. Provide legal description. n <br /> O <br /> PLOT PLAN v N <br /> c <br /> Z v <br /> o a <br /> y <br /> N <br /> O <br /> 1 � � <br /> 0 <br /> 9� <br /> b <br /> 0 <br /> o <br /> R.0 <br /> Z <br /> Z <br /> 0 <br /> Z <br /> IIIL9 <br /> I I� <br /> M <br /> O a=C1m <br /> m < no. <br /> 9 NC0 =0 <br /> N : N O J 0 <br /> Z 0 : .z 1 <br /> O ] : <br /> m <br /> o c C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my . b <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all m <br /> ' <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that Aa : p <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a o <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized ` <br /> person to have access to the bove described premises at any reasonable time for the purpose of inspection. <br /> T <br /> r / G <br /> SIGN HE <br /> Is Cre of owner uilding contractor) (date) t 1 [ o o <br /> N� <br /> o: o <br /> ZONING ADMINISTRATOR `: o I : o <br /> �: nT <br /> TOWNSHIP PERMITS MAY BE REQUIRED c m <br /> O O O O O O O W <br />