Laserfiche WebLink
Burnett County 7410 Co. Rd. K, #102, Siren, WI 54872 Office of Zoning Administrator .1Z 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> 0 <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 <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- <br /> tions <br /> _of the State of Wisconsl <br /> �/ C m <br /> O ER Pr' t - Contractor or S, eyor or Agent <br /> City,State,Zi oda / /7 CC,State,Zip Code — <br /> 1 <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving Q P <br /> Sanitary Camping Unit o o <br /> Privy Subdivision 0 »- <br /> r <br /> Structure Use: 0 <br /> (family home/cabin, garage,addition,etc.) o o <br /> a <br /> 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). <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. 0 <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, <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 <br /> the owner. 6. Provide legal land description. <br /> 0 <br /> PLOT PLAN <br /> o y <br /> c <br /> Z a <br /> o a <br /> 0 <br /> 4 O <br /> See A- ad <br /> u, <br /> I <br /> o) <br /> o <br /> 0 <br /> N � <br /> n <br /> m <br /> m <br /> Z <br /> 0 <br /> Z <br /> 9 <br /> i m ate '-a0 =am <br /> 5 <br /> ^5i` a 5 dc600 !a <br /> o 5— . ' o2 -q <br /> z 3 � - - I o o: � , : � <br /> 0 N <br /> «€ m <br /> r ` n i A <br /> o i ' E ca C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my S <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all m <br /> information contained in this application(including an accompanyingschedule and I further declare that I recognize that ^ ' p <br /> PP C 9 Y ) 9 <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a o <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> SIGN HER <br /> (sig ur of owner orb/ding contractor) (date) o E o <br /> o: o <br /> ZONING ADMINISTRATOR T <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> o 0 0 o Cn <br />