Laserfiche WebLink
n(� C q-4 <br /> Burnett County 7410 Co. Rd. K. , 1102, siren, MI 54872 Office of Zonin?Admiinistrator 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 —_ <br /> d _ o <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 Bur- m <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- <br /> tions of the State of Wisconsin. <br /> ` c <br /> t, �9� r o Su 6L iJ n F <br /> OWNER(Please int) C Contractor or ury or or g nt <br /> f <br /> A dre AA��u <br /> S Ze,,O/L, k4C <br /> City,State,Zip Code CI y,State,Zipode <br /> !-T — <br /> 7n- ;79 �f <br /> Telephone Telephone Q-- <br /> Permit(s)Applied for: <br /> New Building Filling/Grading <br /> Addition Moving g <br /> Sanitary Camping Unit n o <br /> Privy Subdivision m .`.- <br /> �1 <br /> Structure Use:��l I ' /�On l� <br /> (famil home/cabin, garage,addition,etc.) o 0 <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. <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. <br /> O <br /> 0 <br /> PLOT PLAN <br /> 'R y <br /> Z c <br /> a <br /> N <br /> O <br /> 1 � <br /> C� <br /> P-- <br /> C. <br /> 2 <br /> — ' o <br /> N <br /> O <br /> 0 <br /> MZ <br /> Z <br /> I <br /> LD. <br /> dd�am'o <br /> a =1 d 0M(p <br /> N O 7,O <br /> OZ j <br /> M <br /> € D <br /> o i C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all ,,c : m <br /> information contained in this application(including an accompanyingschedule and I further declare that I recognize that a O <br /> PP (� 9 Y 1 9 <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a oo <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing n <br /> `n 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 premisy at any reasonable time for the purpose of inspection. <br /> -n <br /> N <br /> r' <br /> SIGN HERE i <br /> (signatur f wner ilding contractor) (date) <br /> o: o <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED u`^'0 N''N m <br /> v u 00 <br /> o' obo00 <br /> 0 TO cS 000 <br />