Laserfiche WebLink
(v �� � <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator to a <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the M m <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and oa <br /> regulations of he State of Wisconsin. <br /> f <br /> 0=(Please rint) Contractor or Surveyor or Agent o <br /> LIZ- <br /> Addle srs / 5 / _ } Address <br /> City, State Z' Code jtZ C' ,State,Zip Code C� <br /> Telephone Telephon <br /> td:Z4 A� 3 S <br /> ETWgwenc /FiDUd Name <br /> S <br /> QI <br /> Legal Description (as Indicated on tax statement) <br /> Permit(s)Applied for: o ° J <br /> N w <br /> Dwelling Addition Filling/Grading Camping Unit <br /> Z <br /> 0 <br /> Accessory Building Sanitary Privy Subdivision ° m <br /> Garage <br /> Structure Use: A' 6& <br /> (family home/cabin,garage, dkion,etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: C <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). X o <br /> 2. Show the location of the well (W),septic tank(ST),and drainfield (DF). C) 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 ? c <br /> 300 ft. on Z <br /> 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 n m <br /> to lake, river or stream,If applicable. m <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 /> 0 Z <br /> I <br /> S�lt�O ':e7" /,,o . , c <br /> v � <br /> m <br /> 7) <br /> m >n F m <br /> m, pii•� I-'a oo '� D <br /> 9 < . Z N o 5 m <br /> O N 'O 2 <br /> F T y S <br /> / 4 m <br /> $ a $ :4L Au ' M <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief It is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- wm, :w : 0 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. 1 8 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- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> o o: <br /> access to the above described premises at any.reasonable time for the purpose of inspection. : m <br /> V A N <br /> Q� A <br /> SIGN HER s'-�' 7 znpo <br /> (signal owner or g contractor) (date) o; s <br /> VJ <br /> ZONING ADMINISTRATORg ' <br /> TOWNSHIP PE TS MAY BE REQUIRED o o m <br /> $ 888 ) <br />