Laserfiche WebLink
Oil r �. <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratord o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d <br /> zo <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 a <br /> tions of the State of Wisconsin. 67 <br /> \ <br /> WIIIatn i3rCC-kn J <br /> OWNER(Please Pri t) Contractor or Surveyor or Agent n E <br /> nttSd <br /> Address Address '� t <br /> fflnk.. �Y1�1 SS�OIc <br /> City, ate, ip Code City,State,Zip Code <br /> i <br /> Telephone Telephone <br /> �r]CPO tone � n� �d l l)Qbs� r l tl Cmq <br /> Emergency/Fire No. and Road 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 ,,I Privy Moving Subdivision 6 <br /> Structure Use: ` J�RD6EZ <br /> caa�)< aaf a <br /> o <br /> (family home/cabin, garage, type of addition, etc.) 0 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. ^°r <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 ordi- <br /> nary high water mark of 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 dated by <br /> the owner. 0 <br /> PLOT PLAN <br /> N. <br /> I O <br /> J <br /> A <br /> ' ay <br /> 11` Z <br /> i t � <br /> ' 1 <br /> C� rlv <br /> a<>yN> n <br /> i ` a <br /> m <br /> V of i C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o: 0 y <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- ' 'o j m <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 a <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- <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. <br /> SIGN HERE <br /> (sign ure of own or bu ding contractor (date) <br /> o: o <br /> ZONING ADMINISTRATOR L— <br /> m <br /> NNON� NT <br /> TOWNSHIP PERMITS MAY BE REQUIRED U N T N O U <br /> 00000 0 <br /> 00000 <br />