Laserfiche WebLink
Burnett-County 7410 Co. Rd. K, #102, Siren, WI 54872 Office of Zoning Administrator co m _0 ( o Z <br /> APPLICATION FOR — LAND USE — PERMITS d 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 'z rn <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m 0 <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 <br /> tions of the State of Wisconsin. <br /> 0 <br /> N � � <br /> 0 <br /> OWtR(Plea fe Print) Contractor or Surveyor or Agent o <br /> m <br /> Address � <br /> w 1 <br /> City,State,Zip Coder_q FF <br /> City,State,Zip Code ' PT <br /> Telephone 'L Telephone 1 <br /> f� <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving p <br /> Sanitary _ Camping Unit <br /> o <br /> Privy Subdivision o <br /> p " r <br /> Structure Use: nI1,-�r`..{ ('Jn <br /> T ( amity home/cabin,garage, addition, etc.) 0 3 <br /> a <br /> m <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 /> I� <br /> 2. Show the location of the well (W) septic tank(ST), and drainfield(DF). <br /> 3. Show the location of any lake or flowage-it within 1000 ft. and the location of any river or stream - if within 300 ft. <br /> 4. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building to lake, <br /> river or stream, if applicable. (� <br /> 5. If,separate plans are submitted by an architect,engineer,build ntractor,etc.,the plans mu signed and dated by <br /> the owner. <br /> O <br /> 0 <br /> PLOT PLAN 3 <br /> a y <br /> Z Q <br /> o a <br /> Sin <br /> r (7/ <br /> C D o <br /> o r <br /> 01) <br /> h <br /> O E <br /> I <br /> / <br /> N <br /> N <br /> O <br /> t <br /> o <br /> M N ID >>W-0 <br /> n a ? <br /> 00-cm <br /> LD. a many <br /> ° cmo�3 <br /> y N O 7 ° <br /> m <br /> OZ 5. � 1 <br /> 0 . p <br /> Jo! c C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all m <br /> information contained in this application(including an accompanyingschedule and I further declare that I recognize that <br /> PP f 9 Y ) 9 � O <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a 'o <br /> permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am providing o <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized ' p <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> m <br /> m <br /> SIGN HERE <br /> i ture of owner building contractor <br /> 9 P{ 9 ) (date) <br /> ZONING ADMINISTRATOR <br /> e I' to T <br /> N ONL N <br /> TOWNSHIP PERMITS AY BE REQUIRED n, o <noou" <br /> 0 00000 <br /> 0 000 <br />