Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ( ; o 0 <br /> 3- <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <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 n <br /> regulations of the State of Wisconsin. r' <br /> N d <br /> y <br /> M -14 <br /> = f <br /> OWNER (Please Pr i Contractor or Surveyor or Agent o <br /> i o soq - (1d 70 <br /> ATssI`P�� I Address <br /> 1 t <br /> ate, Coe City, State, Zip Code <br /> City <br /> �/Sts, Zip 2911 -ami W r <br /> Teie.�2b C �. ( .70 Telephone w <br /> Emergency/Fire No. and Road Name <br /> 1 <br /> Legal Description (as indicated on tax statement) <br /> n 0 <br /> Permit(s) Applied for: <br /> N ^ <br /> Dwelling Addition Filling/Grading Camping Unit ° <br /> Z 'o C <br /> Accessory Building Sanitary Privy Subdivision z r <br /> Garage �r " r <br /> n,�I t A <br /> Structure Use: r-> o <br /> (family home/ca in, garage, addition, etc.) <br /> 0 +- <br /> DIRECTIONS FOR PLOT PLAN DRAWING: X1 <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 (NI),septic tank (ST), and drainfield (DF). o { <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. z C c, <br /> o <br /> � 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 - = o <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 C <br /> dated by the owner. 40 ..w C' S <br /> PLOT PLAN <br /> 1 <br /> See A4.acj)� /ate <br /> i <br /> a <br /> J <br /> _o <br /> N IL <br /> A <br /> \nIN) z <br /> / IIL.O <br /> I <br /> m <br /> '^ < 71 QHo <br /> - <br /> P f S : Trp: M <br /> F � O <br /> 8 n <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o a `� 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- 0 <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 g m g <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 0 N O <br /> access to the ab ve describe premises at any reasonable time for the purpose of inspection. r 3 $x <br /> SIGN HERE <br /> (signet a of ow r building co rector) (date) v c ? Fr i <br /> > lGrl° u <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 888 $ 8 $ 8rmn <br />