Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U) 3 Z <br /> j ° <br /> APPLICATION FOR — LAND USE — PERMITS d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m v ! <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> 3 a <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and o <br /> regulations of the State of Wisconsin. <br /> N � <br /> rD <br /> f <br /> OWNER (PI as Pring / r Contractor or Surveyor or Agent m J <br /> Add re '/ Address <br /> %�7/J�U'7/L��/77�C/ �3-Y <br /> City, St�tp, ode�3_ ��/' � City,State,Zip Code <br /> Tele R/o(no� '9oS Telephone <br /> Legal Description (as Indicated on tax statement) <br /> 0 <br /> Permit(s) Applied for: <br /> Dwelling Addition Filling/Grading Camping Unit °� 3 <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision ° <br /> Garage <br /> Structure Use: <br /> (family home/c—� abih, garage, ad —i n, 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). 0 <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 3m <br /> 3. Show the location of any lake or flowage- if within 1000 ft. and the location of any river or stream- if within Z <br /> 300 ft. ° n <br /> 4. Show dimensions infeat of the following:(a) building to all lot lines,(b)building to center line of road,(c)building y <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 <br /> dated by the owner. m <br /> PLOT PLAN <br /> 0 <br /> T M <br /> ° <br /> 0 <br /> aj/ <br /> Z <br /> I <br /> NN _� mr- DDo M <br /> o m m m a F m <br /> °Z o T M <br /> m <br /> C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o IT <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 C <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 8 ro <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $ $ <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- e. <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. 0 8 n E <br /> m ° <br /> SIGN HERE 1tn <br /> (signature of owner or budding contractor) �J ICi- `1d�fa<) fl `• �.. o s <br /> 8 <br /> ZONING ADMINISTRATOR a <br /> NOV <br /> TOWNSHIP PERMITS MAY BE REQ 9' C <br /> $ 8 888881 <br />