Laserfiche WebLink
�_'&q " <br /> Burnett County 741Q Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w v z <br /> m F o <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> Y <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 O <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance, Sanitation Cod and with all other applicable County Ordinances and the laws and . n <br /> regulations of the State of Wisconsin. rn , <br /> «n/ R N <br /> 0 <br /> OWNER (PI ase Print Contractor or Surveyor or Agent o <br /> dress � Address i r� <br /> City State, Zip de City,State,Zip Code <br /> -3388 <br /> Telephorig Telephone <br /> �7�=S,S /�M�tsc�,✓ ��. , �C��f3.S7�z' 1 i -> <br /> Emergency/Fire No. and Road Name <br /> '�r�ti`w / 9nAcrEs s� ✓pP/a�,. /yrs .�✓a�r�ori �sryr� - <br /> Legal Description (as Indicated on tax statement) �'jl/ &0VOO OT?ZI) � <br /> lv <br /> Permit(s) Applied for: o <br /> r <br /> Dwelling Addition Filling/Grading Camping Unit o ° <br /> v <br /> Z 'o <br /> Accessory Buildings Sanitary Privy Subdivision ° <br /> Garage n <br /> Structure Use: �+ � L- (-.AeA%,L r <br /> (family home/cabin, garage, addition, etc.) <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: 0 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). M <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 0 ° <br /> 3. Show the location of any lake or flowage-if within 1000 ft. and the location of any river or stream-if within .0 c m <br /> 300 ft. on z it <br /> o n <br /> 4. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building 0 <br /> to 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 C 1 = <br /> dated by the owner. 10 <br /> III �.1 <br /> PLOT PLAN -^ <br /> f <br /> A16 0_ <br /> 36 ' /t'oz .- 3a a �t em . 3 gra <br /> -w-le e _ cowu'.1 Oq sem- xc, <br /> ��- <br /> fgl�. m o � � mm � ag � <br /> o P� I Il slimy gu"dln-T be //D - a a� o 3 <br /> I < H : 2 N o = p <br /> or <br /> stwk�s. f m <br /> � ; a <br /> SwLL4 b-- At 1.4,s7(- r,� .5`4T Am Lt+' 01' ' N i € o <br /> mE : c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m : <br /> � ` m <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs- d,Et m <br /> w O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 8 'N � <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $ g <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. m 8 r? <br /> -� ,3 <br /> n <br /> SIGN HERE <br /> (q N <br /> (st atuiv, ovilner it g contractor) - (date) <br /> ZONING ADMINISTRATOR g <br /> _ t8888 ' <br /> x <br /> TOWNSHIP PERMITS MAY BE REQUIRED i; ' MAy 2 O )"v N $N o o MM <br />