Laserfiche WebLink
�Y\ LGY1 ) f, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator C0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> °i g S <br /> N <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m P1 <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur. m <br /> nett Count Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 <br /> tions oft State of Wis nsin. <br /> OWNER(Plea a Print)) Contractor or Surveyor or Agent <br /> m (� <br /> Address Address I <br /> V' <br /> City, State,Zip Code � City,State,Zip Coder <br /> Telephone Telephone ,.-..r� �D <br /> Emergency/Fire No.. and Road Name <br /> X b v r✓ /8li CcJ <br /> Legal Description(as indicated on tax statement) <br /> Permit(s)Applied f O <br /> 0 <br /> `c <br /> New Building Sanitary Filling/Grading Camping Unit w ' <br /> Addition Privy Moving Subdivision o - ��-- <br /> grct - ' �y 3 � 0 <br /> Structure Use: � . <br /> (family home/cabin, garage,type of addition, etc.) } <br /> l <br /> Directions for plot plan drawing: iI <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). <br /> 3. Show the location of any lake or flowage-if 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 ordi- <br /> nary high water mark of lake, river or stream, if applicable. <br /> 5. If,separate plans are submitted by an architect,engineer, builder,contractor,etc.,the plans must be signed and dated by <br /> O <br /> the owner. 3 <br /> a <br /> PLOT PLANZ C <br /> c <br /> Q <br /> l� o <br /> See , ( <br /> a, <br /> 0 <br /> O li <br /> (� <br /> J <br /> s <br /> o <br /> N � <br /> � qfi <br /> Z <br /> D <br /> I� <br /> c�mm nacm � <br /> m K� »'nm REM <br /> a <' d c y 3's, F. <br /> n E 2 o °m <br /> :� m <br /> 0= O <br /> O: i-�o R C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o J <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- m <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. I :m <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- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above describy premises at any reasonable a for the purpose of inspection. <br /> T .N: <br /> N <br /> N ' <br /> Y1;0; <br /> SIGN HERE <br /> 0� 0 <br /> (s' a re of owner or i ing contractor) (date) v : :m 0 <br /> 0 <br /> ZONING ADMINISTRATOR <br /> pq �Nn�uNo <br /> TOWNSHIP PERMITS MAY BE REQUIRED °o 0 <br /> 00000 <br />