Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w --o <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> u o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 'z y <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. <br /> OWNER (Please P inePrt) Contractor or Surveyor or Agent o <br /> / �o � <br /> Address Address <br /> hCcl-al z�y" f 100 '5"5-)-z3 n <br /> City, state. I■,o-2- /_�`a 3 City, State, Zip Code <br /> Telephone �J /� Telephone <br /> ��70-}� ,L ,fie R�• , <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as indicated on tax statement) 0 1 1 <br /> ct <br /> Permit(s)Applied for: o — <br /> N � n <br /> Dwelling Addition Filling/Grading Camping Unit <br /> 0 0 <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision <br /> Garage <br /> ' <br /> Structure Use: Add, b(7y) o <br /> (family home/cabin, garage, addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: C <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). X n <br /> 2. Show the location of the well (W),septic tank(ST), and drainfield (DF). () 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 c <br /> 300 ft. o a <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 0 <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 /> 0. <br /> PLOT PLAN <br /> 1 <br /> yam-- <br /> Sw � <br /> iS <br /> 0 <br /> f <br /> or s <br /> t- N <br /> s <br /> NNS Nr- DDO M <br /> M <br /> D a m <br /> Z p N ,z 1 <br /> Fes : TN Xo <br /> = ^ m <br /> r i c D <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- : S M <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 informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- $m <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 <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 N <br /> access to the above described premises at any reasonable time for the purpose of inspection. m I 0g <br /> N 3 A N <br /> A N <br /> (q N 8 <br /> SIGN HERE ' E <br /> ign re ner or building contractor) ) [ o s <br /> ZONING ADMINISTRATOR 0C $ <br /> TOWNSHIP PERMITS MAY BE REQUIRED 1 i; JUN 2 2 I i%`^" <br /> ! I`(jN N N N O O s O m <br /> 88888888M <br />