Laserfiche WebLink
Burnett Cowty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratoro 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <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 <br /> regulations of the State of Wisconsin. (( H m <br /> A1kav` p. �tr ��� �1u :te7 �zt� ��CL .t a f <br /> OWNER (Please Pr t) /� (� + Contractor or Surveyor or Ag v <br /> ?1A QUA :r3%Liyt Uc'v. <br /> Addr ssAddress <br /> W, <br /> W"ler 1 JrL�o <br /> City, State, Zip Code City, State Zip Code <br /> CaJQ�aS}Qr UU 5 L(K `1 3 <br /> Telephone Telephone ,5 1 ' <br /> 7r5— %A) -3713. <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as indicated on tax statement) <br /> n c <br /> 0 <br /> Permit(s) Applied for: <br /> '^ r <br /> Dwelling Addition Filling/Grading Camping Unit ° <br /> Z :? <br /> 0 0 <br /> Acc ildin Sanitary Privy Subdivision a <br /> Garage / r <br /> Structure Use: l r7c,J till p ay x 3� o <br /> (family home/cabin, garage, addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: G <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). X O <br /> 2. Show the location of the well (W),septic tank (ST), and drainfleld (DF). C o W3. Show the location of any lake or flowage-If within 1000 ft. and the location of any river or stream- If within an W <br /> 300 ft. o 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 111 w <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 /> L <br /> 0 <br /> N <br /> o <br /> w <br /> I <br /> Z <br /> m o c m m on g m <br /> mo. 00 am 9 <br /> c 0 5 - Z H o m' z' <br /> Zo <br /> a <br /> M <br /> 8 <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 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- IJ <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- ro <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I m <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 0, <br /> access to the above described premises at any reasonable time for the purpose of inspection. „ 3 <br /> (/\{ ((J� A �� ���,� C) \ 11/x' <br /> SIGN HERE <br /> (signature of owner or b 'Id g contractor) (date) o x <br /> ZONING ADMINISTRATOR <br /> H(A �NV1(p tl1T <br /> TOWNSHIP PERMITS MAY BE REQUIRED N &N o o 8 m <br /> $ 88 $ $ 888ai <br />