Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator En d -.0 -0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> ;u o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 7 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the c <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations <br /> /o/ff the <br /> State of/Wisconsin. y <br /> n � <br /> F <br /> OWNE I int) Contractor or Surveyor or Agent <br /> m <br /> m' <br /> Add re ai Jelb Address <br /> City,Stat� ?Ip�Code City,State,Zip Codec <br /> Telephone 9� �m / C Telephone <br /> Eme g� cy/Fi Ta <br /> <_- R ��/�/• / T �J7' ✓ <br /> Legal Description (as Indicated on tax statement) o <br /> 0 <br /> Permit(s) Applied for: o < <br /> '^ r <br /> Dwelling Addition Filling/Grading Camping Unit o g <br /> z o <br /> Accessory Building Sanitary Privy Subdivision P <br /> Garage /� } <br /> Structure Use: ��C <br /> (family home/cabin, ga(ge, addition, at/) S <br /> 71 (� <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 /> 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 P y <br /> 300 ft. Z <br /> 4. Show dimensions in feet of the following:(a)building to all lot lines,(b) building to center line of road, (c)building H <br /> to lake, river or stream, if applicable. M ;zJ o <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C I ' <br /> dated by the owner. m <br /> PLOT PLAN <br /> )J <br /> I 5 <br /> ^. <br /> 6 <br /> 0 <br /> 0 <br /> m <br /> O y <br /> N I' <br /> NNj� <br /> ^ ( <br /> C<l <br /> Z <br /> ( 31 <br /> D Nfn � fnrDDO V <br /> 00 o . m m a f m <br /> N <br /> Z o <br /> P f N M <br /> — m <br /> 61 O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o N 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- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- f� 8 W N <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ m 8 <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 c, <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 8 m <br /> 17 A N <br /> SIGN HERE /A5AX//// <br /> (signature f owner or))vilding contractor) (date) , <br /> ZONING ADMINISTRATOR �CJ-�� <br /> fR � w(Aw T <br /> TOWNSHIP PERMITS MAY BE REQUIRED N o o m <br /> 8 8 888m <br />