Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator to ' o a <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w o <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 _ o. <br /> reguatio sof the State of Wisconsin. H o <br /> Oki r%W1STK(-.Q <br /> 0 ER (P a <br /> 0 . Rc-tW-IT k rZo . <br /> �d r 6, <br /> K�>j Sn� Address <br /> Cit StSta��te, Zli(/Cod2 ` City, State, Zip Code <br /> IIS — r) q <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name <br /> I <br /> Legal Description (as indicated on tax statement) o -- <br /> 0 <br /> Permit(s) Applied for: o` 0 <br /> 0 <br /> N r <br /> Dwelling Addition Filling/Grading Camping Unit o °— <br /> Z <br /> ° <br /> Accessory Building Sanitary Privy Subdivision om <br /> Garage <br /> Structure Use: m m <br /> (family home/cabin, garage, addition, etc.) <br /> 0 <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). M n <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). G <br /> 3. Show the location of any lake or flowage-if within 1000 ft. and the location of any river or stream- if within ino <br /> 300 ft. anz � <br /> o <br /> 4. Show dimensions in feet of thefollowing:(a) building to all lot lines,(b)building to center line of road,(c)building n , <br /> to lake, river or stream, if applicable. fill <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. (p <br /> PLOT PLAN <br /> AlfiAc �{cn ' <br /> s R\ <br /> w \A. <br /> c� <br /> 1 w <br /> `J N z <br /> 8 <br /> I <br /> Q <br /> o c m m o a <br /> Lim M <br /> < - Z0oMm3 <br /> 2 A o m Z 1 <br /> cCt m M <br /> c C <br /> g : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accurac of all informs- m <br /> 9 P 9 P Y am wt O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- . $ m N <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 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- <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 mises at any reasonable time for the purpose of Inspection. : w' m <br /> 3 A <br /> H n O <br /> SIGN HERE <br /> (signature of owner buildi contractor) (da e) <br /> ZONING ADMINISTRATOR <br /> N A H H H T <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N o o $ m <br /> 8 $ 88ai <br />