Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d " 0 0 <br /> APPLICATION FOR - LAND USE - PERMITS3. <br /> W o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes applicatio ork described and c `lV <br /> located as shown herein. The undersigned agrees that all work shall be In accordance with the r 'rements of the m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all o applicable County Ordmanc an a laws and A <br /> regulations of the State of Wisconsin. H m° <br /> AX <br /> M O <br /> E <br /> OWNSff lease int) Comr toro ry o o m o <br /> /� m m <br /> m <br /> Add; s� ��_ AdIs <br /> City, State, Zi Codd City, e, Zip de _ ) <br /> Telephone Telephone "1 <br /> `1 <br /> Enjerg n /Fir No. and o d Name ?� <br /> 5 C 4. /x <br /> Legal <br /> Legal Description (as indicated on tax itaterne <br /> Permit(s)Applied for: 0 o - <br /> m <br /> Dwelling Addition Iling/Grading Campi nit ° <br /> v "I <br /> Z o <br /> Accessory Building Sanitary Privy division q <br /> Garage `r <br /> Structure Use: <br /> (family home/cabin, 4arage, addition, tc.) UI <br /> DIRECTIONS FOR PLOT PLAN DRAWING: 0 C <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). o <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DIF). 0 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 <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 1111111 m. <br /> to lake, river or stream, if applicable. n c- <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. n <br /> PLOT PLAN <br /> o J <br /> Z <br /> o c m m a F m <br /> m. aa'� aN am m <br /> Z o M <br /> oar q m <br /> _ M <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 informs. G): <br /> O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 - g 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- y, <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have N <br /> O o : <br /> access to the above described premises at any reasonable time for the purpose of inspection. m g m <br /> m : v A w <br /> SIGN HERE <br /> (signature of owner or building contractor (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED FN N & o o 9 m <br /> 88888gm <br />