Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d 'o a <br /> APPLICATION FOR — LAND USE — PERMITS3_ <br /> m a <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q N <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. m m <br /> 0 NER (Please Prin / � Contractor or Surveyor or Agent �L��+��'+ . o r� <br /> Add ss 1 I)all ��(>�j n AI aL265 4 1_ f 6,0,) , .Fel 3 m j MIN1 <br /> City, State, Zip C64e City, State,Zip Code <br /> D <br /> Telephone —� 711�1� Telephone <br /> Emergency/Fire No. and Road Name n <br /> Legal Description (as indicated on tax statement) <br /> t` <br /> Permit(s) Applied for: 0 o <br /> Dwelling Addition Filling/Grading Camping Unit on <br /> v <br /> Z a <br /> Accessory Building Sanitary X y Subdivision ° <br /> Priv <br /> Garage <br /> Structure Use: <br /> 0 <br /> (family home/cabin, garage, addition, etc.) <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 dralnfield (DF). 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 v <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 <br /> to lake, river or stream, if applicable. M t �1 <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. <br /> In 9� <br /> PLOT PLAN v'J <br /> 1 C <br /> O S <br /> O <br /> 0 <br /> / 1 0 <br /> VI o <br /> nf60 <br /> o <br /> w <br /> 0 <br /> Z <br /> I I� <br /> f <br /> � '0 T W ag 'U <br /> OC 161990 <br /> a <br /> .' ' Z FD" AZ : i <br /> m <br /> F m c C <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- [ Fn <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 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- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have nN o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 3 g a <br /> m v A m <br /> p N <br /> SIGN HERE <br /> (signature <br /> of owner r building contractor) (date) c <br /> ZONING ADMINISTRATOR <br /> w <br /> TOWNSHIP PERMITS MAY BE REQUIRED U <br /> 8888 $ 888rmn <br />