Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator Cn 7 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d 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- <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 th State of Wisconsin. w <br /> OWNER lease Print) � p Contractor or Surveyor or Agent f <br /> a �S� � fW . .S <br /> Addres Address <br /> City,State,Zip� <br /> Telephfygd� I J City, State,Zip Code 1 <br /> one jJ l�0 ,1� �� Telephone <br /> a�sc� 0 Jt�s�n � d � <br /> Erryef9me <br /> @-n�oylF N C I� �I-�Na 0+ (-VC. <br /> Legal Description(as indicated on tax statement) o J <br /> Permit(s)Applied for: <br /> 0 <br /> New Building Sanitary Filling/Grading Camping Unit 0 .`.- <br /> Addition Privy Moving Subdivision o <br /> v <br /> Structure Use: 1Qt.. o R <br /> (family hometcabin, garage, type of 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). J1� <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 <br /> the owner. <br /> 0 <br /> `` n 3 <br /> PLOT PLAN fit` A} A(^EP Copy z c <br /> 1 o Q <br /> a <br /> o <br /> P = <br /> W <br /> s <br /> I <br /> o <br /> N Q) <br /> I <br /> s 0 <br /> N <br /> luv/� <br /> IC <br /> 0 <br /> 0 Iv <br /> i z <br /> N <br /> M mvtnr DDmy <br /> m c .0 w 0 a c <br /> 0 a< 3 = 0a= <br /> m a� am =;n � <br /> "c m Ei 3 <br /> w' `z 0 =t0 <br /> _ : tj <br /> (»cn � <br /> PA: : f—'2 i m <br /> o =o : C <br /> i0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa. ,0"I b) a m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. V- m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue at permit. I (? xfln <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 /> v: <br /> access to the above dITcribed premises at any reasonable time for the purpose of inspection. iea: <br /> SIGN HERE <br /> (snatur of owner or b contractor) (date) <br /> ZONING ADMINISTRATOR <br /> T <br /> �UNON <br /> O U ti O , O <br /> TOWNSHIP PERMITS MAY BE REQUIRED $S S S o S N <br />