Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS a3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 2 y <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 1 <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulatio s of the State of Wisconsin. m <br /> OWNfft jPleasoint)/// � 1 Contractor or Surveyor or Agent o <br /> �C(� / N m <br /> Address Address <br /> IX-lbaaza A) 19211 55S9i <br /> City�jate� _ / D City, State, Zip Code <br /> m <br /> I elepCnoone CJ Telephone <br /> E er en /Fir No. an a <br /> �o� /f5rn �� -.��(o /LvI'd _ <br /> Legal Description (as indicated on tax statement) <br /> o J <br /> Permit(s) Applied for: o It <br /> Dwelling Addition Filling/Grading Camping Unit = <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision o <br /> Garage <br /> Structure Use: <br /> - <br /> (family home/ abin, garage, ddition, etc.) '7 P <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). 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. on 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 n H <br /> to lake, river or stream, if applicable. m <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. H LSI <br /> mUj <br /> PLOT PLAN <br /> C <br /> U " <br /> 0 <br /> 0 1 <br /> J C <br /> � Z <br /> i <br /> 0C w DaF rail <br /> 0 <br /> < o Z o <br /> — m <br /> G) oi O <br /> 8 o c C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o '^ `� 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- `b' m u, <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 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- N <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have v, <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 3 8 0 <br /> 3 A m l <br /> 8 <br /> SIGN HERE�c,IQ�'e '`�/ K�/7') /d"�1�� w I <br /> N <br /> (signet r f owner or building contractor) (date) o x <br /> ZONING ADMINISTRATOR_ <br /> Fn e+«+w m <br /> N N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED o u o o S m <br /> C 8 888 (Mn <br />