Laserfiche WebLink
C)Y-\ Co1)P <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d - a o <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 <br /> N <br /> s <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m m <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula. 3 n <br /> tions of the State of Wisconsin. o <br /> OWNER(Please Print) Contractor or Surveyor or Agent n F <br /> Address �. Cc Address UJ <br /> Q =? <br /> City, tate u ,` OO ) City,Zip Cod <br /> Telephone Telephone <br /> 128Coyd'l�-u (= <br /> Emergency/Fire No.antl Road Name <br /> Legal Description(as indicated on tax statement) o <br /> Permit(s)Applied for: 0 o <br /> New Building Sanitary Filling/Grading Camping Unit 0 <br /> 0 <br /> Addition Privy Moving Subdivision g rT <br /> 71 0 <br /> Structure Use: Ajo P a <br /> (family homeicabin, 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). 1- <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. 1I <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, Q <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 O <br /> the owner. <br /> 7I <br /> 3 <br /> N <br /> PLOT PLAN 'II z o <br /> 0 <br /> wt <br /> 0 <br /> M -O <br /> 311 <br /> a <br /> I <br /> N Cn <br /> O � o <br /> 2. <br /> n � <br /> o <br /> m <br /> o � i <br /> N <br /> 6) z <br /> 1 � _ <br /> 3 <br /> m c 1�In tDincm <br /> ma� —nm nn9 <br /> v < m C w o <br /> Z w: `� m0 �m C <br /> C' <br /> U/•fri =2 m <br /> Win ; A <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of m knowl- <br /> edge <br /> PP ( 9 Y ) Y Y <br /> edge and belief it Is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- Q=: ; m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- +'' i H - E 0 <br /> V i <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 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 reasonable time for the purpose of inspection. ! n o <br /> m 3 <br /> �-/y m a <br /> SIGN HERE 5 0 <br /> Ct `O ` 0 <br /> (si at a of owne^or uilding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> - WN�MlAHH71 <br /> �` TOWNSHIP PERMITS MAY BE REQUIRED g g g g o$8 y <br />