Laserfiche WebLink
�, <br /> ER/SCANNED ON COMPUTE � C ) ) v <br /> Bi,irnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w T o 0 <br /> 'APPLICATION FOR — LAND USE — PERMITS 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m c <br /> I CD <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 /> Cn <br /> OWNER(Please'Print) co C i/ Contractor or Surveyor or Agent CDQ f <br /> CD <br /> Add r ss Address ' <br /> S �e <br /> City State,Zip Code City,State,Zip Code <br /> Telephone Telephone J <br /> Emer ency/Fire No.and Road Name f ,� <br /> Legal Description(as indicated on tax statement) r—T <br /> Permit(s)Applied for: o 0 <br /> 0 <br /> New Building Sanitary Filling/Grading Camping Unit 3 `. <br /> N <br /> Addition Privy Moving Subdivision o w C <br /> Z <br /> Structure Use: P 'a° <br /> (family home/cabin, garage, addition,etc.) a <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). A ° <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. 11 fi <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, 0 <br /> river or stream, if applicable. X <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and dated by n <br /> the owner. <br /> 0 <br /> on 3 ? rn <br /> PLOT PLAN 01 o `v <br /> a <br /> m '- y <br /> c C ' ' 0 <br /> (P a <br /> W a <br /> (n <br /> O <br /> C� O GI <br /> 7 <br /> m <br /> o r <br /> y � <br /> m woacm c=0 <br /> o Q —•< > > oam <br /> m aIc — aco a� <br /> � y � f/Ci p 7fG 3 <br /> (D <br /> O ; <br /> � 10 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- v o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- G7,�E , 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 <br /> further accept all liability which may be a result of the Count of Burnett relying on this information I am providing in this ap- <br /> plication. <br /> P Y Y Y Y� 9 P 9• �: '• o• o; <br /> I agree o permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the ab ve described premises at any reasonable time for the purpose of inspection. n p <br /> m aw <br /> N O ,0 ' <br /> SIGN HERE ' -y o <br /> na re o in owner "` o <br /> ( .9 9 contractor) (date) � o <br /> ZONING ADMINISTRATOR (� E <br /> ifl i�j ifl 64 Go ifl'n <br /> TOWNSHIP PERMITS MAY BE REQUIRED (� N m <br /> 0 0 000 <br /> 000 5000 <br />