Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ,� 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <br /> 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 0 <br /> tions of the State of Wisconsin. `" m <br /> y W <br /> C <br /> N t] <br /> e Contractor or Surveyor or Agent ^p <br /> O ER Z <br /> (Please Print�� m � <br /> Add—_r ss Address , <br /> F,rsv �� .��Y� City,State,Zip Code <br /> City,State,ZI�Code � <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name <br /> ' N r '/ <br /> Legal Description indicated ton—tax statement) � <br /> Permit(s)Applied for: <br /> /1 tory <br /> Filling/Grading Camping Unit New Building Sanitary " 0 <br /> Moving Subdivision o <br /> Addition Privy g <br /> G�xp Z o <br /> Structure Use: -O <br /> (family homelcabin, garage, type of addition,etc.) m <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). o <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 O <br /> 0 <br /> the owner. 3 <br /> c N I <br /> PLOT PLAN Jam o c <br /> a <br /> L7_2 <br /> o <br /> Z� d� <br /> J <br /> Y�� <br /> j o` <br /> ( U <br /> � Z <br /> L � <br /> 7 0 C W00na. m <br /> U m a� � m1»nom <br /> P EY : 50 <br /> i Qli i 1 <br /> s � i O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o I m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <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 : a <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 described premises at any reasonabl time for the purpose of inspection. m <br /> m <br /> yr <br /> SIGN HERE <br /> (si ture of owne buil i contractor) (date) <br /> ZONING ADMINISTRATOR u. -t <br /> ,ocNm <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 600 <br /> m <br />