Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m -- l o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> m o <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 mm <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regul ns of the State of Wisc nsm. m m <br /> reorc��. Zeo a <br /> OWN RfPlease P Int Contra or or Sury or or Agento „ <br /> Addre s m� 5(o�Or� Addre � y <br /> Or o, r t� 5�x <br /> City, State, Zip Code j City,State,Zip Code <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as Indicated on tax statement) g <br /> o <br /> Permit(s) Applied for: 0 ^- b <br /> Dwelling Addition Filling/Grading Camping Unit <br /> Z 'o <br /> Accessory Building Sanitary Privy Subdivision ° <br /> Garage <br /> Structure Use: � <br /> 0 <br /> (family home/cabin, garage, addition, etc.) <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). n <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 0 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. 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 mZ-- <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. M <br /> PLOT PLAN <br /> c&m w <br /> N <br /> W <br /> n <br /> I �_ I� <br /> A � <br /> 3 <br /> m <br /> o � <br /> w <br /> Z <br /> �4:b1v1ry11I' <br /> I <br /> mo c NN m tDi 6 Fm <br /> s <br /> o <br /> o <br /> 00 0= 1 <br /> 9 <br /> M <br /> a ? c <br /> 8 ' a <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 /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- �n m w O <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 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- <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. <br /> m a A m E <br /> H [ N <br /> SIGN HERE <br /> (signature owner or building contractor) (date) o x <br /> 8 <br /> ZONING ADMINISTRATOR <br /> H' <br /> N NON m <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N N N 8 O 8 O8 m <br /> $ $ 88 $ 888rmn <br />