Laserfiche WebLink
7410 Co. Rd. K, 1102 <br /> Siren, MI 54872 <br /> Burnett Co4nty Office of Zoning Administrator d ' 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and N <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 County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 a <br /> tions of the State of Wisconsin. p <br /> N d <br /> YJ/:L ✓� (A / ey ✓1 ✓-N d O �0 <br /> OWNER(Please Print) Contractor or Surveyor or Agent o <br /> Address _ Address <br /> City,State,Zi Code City,State,Zip Code <br /> �! <br /> Telephone Telephone I — <br /> CA <br /> Permit(s)Applied for: <br /> New Building _ Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit o 0 <br /> Privy Subdivision 0 <br /> m r <br /> Structure Use: S � � ✓� �� h�� v <br /> (family home/cabin,garage, addition, etc.) o a <br /> O <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). <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. o <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,builder,contractor,etc.,the plans must be signed and dated by <br /> the owner. <br /> O <br /> 6P1.0 cle legal description on the side of this form as on tax statement. 0 <br /> C y <br /> Z c <br /> 0 0 <br /> N <br /> e� <br /> A(tacheol <br /> cel <br /> 0 <br /> m <br /> 0 <br /> tD <br /> Z <br /> 0 <br /> Z <br /> 70 <br /> Mcco)-�n SE}iD aid ))C)-c awd <br /> � a� f�� 1 � � a� �m »nS <br /> mo53 <br /> p ApproV <br /> O 0(O <br /> N <br /> Z o � 1 <br /> p N: 9 <br /> �€ m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o m <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all c <br /> n i m <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that <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 ! <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized n��l/// <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> 1 _ m <br /> SIGN HERE <br /> (s' ature of o ner bu' in contractor) (date) o E [ o <br /> ZONING ADMINISTRATOR <br /> L <br /> TOWNSHIP PERMITS BE REQUIRED N N O J <br /> oc9i000 <br />