Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d --I o <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 y <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 3 0 <br /> regulations of the StateofWisconsin. rn m <br /> OWNER (Please Prim Co actor o urveyor prf gent o <br /> Addryss Addr rs , � <br /> �I� <br /> . `3 f� <br /> City, State,Zip Cod City,State,Zip Code', <br /> yyr r, <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as indicated on tax statement) <br /> Permit(s)Applied for: 0 - <br /> 0 <br /> r <br /> Dwelling Addition Filling/Grading Camping Unit <br /> z a <br /> Accessory Building Sanitary Privy Subdivision P m 4 <br /> Garage <br /> Structure Use: r <br /> 0 <br /> (family home/cabin, garage, addition, etc.) on <br /> DIRECTIONS FOR PLOT PLAN DRAWING: 0 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). M 0 <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 11 <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 C� y <br /> to lake, river or stream, if applicable. m C; 0 <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 w <br /> 111 <br /> PLOT PLAN o <br /> L. o) <br /> m <br /> I� <br /> r � <br /> � o <br /> J � <br /> � z <br /> D <br /> A o c ;R m W g a g A <br /> m <br /> a < = : z H o no m 3 <br /> Z -o m ,Z : 1 <br /> O x S T N M <br /> M <br /> 8 'm C <br /> m m i M <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know]- 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- 1— c w m N O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ) i <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- N <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have i 0, <br /> access to the above described premises at any reasonable time for the purpose of inspection. 0 g eo <br /> W a Am ': <br /> N N 8 <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) — 0 <br /> _. o <br /> ZONING ADMINISTRATOR rLr-4,, �j 8 . <br /> TOWNSHIP PERMITS MAY BE REQUIRED 7�-N N n o omm <br /> 88888888rn <br />