Laserfiche WebLink
Burnett C, my 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator T o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> m � v � <br /> TO THE CONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and N <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 0 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. H o <br /> �z ynJm <br /> /eC/ �Q.ilil S O✓( _.11 a f <br /> OWNER (Please Print) Contr for or Suryor A ent o m <br /> Addressress // 3 <br /> I, r,- l SV Pi- �(/i S� 93 �J Gr ri F iLCJ rc, y� <br /> ity, tate, Zip Code City, State, Zip Co t <br /> ��a <br /> Iffi ephone Telephone <br /> Emergency/Fire No. and Road Name <br /> u <br /> Legal Description (as Indicated on tax statement) <br /> n_ 0 <br /> 0 <br /> Permit(s) Applied for: ° <br /> Dwelling 'y— Addition Filling/Grading Camping Unit ° <br /> v <br /> Z a <br /> Accessory Building Sanitary Privy Subdivision P a <br /> Garage I <br /> Structure Use: <br /> (family home/cabin, garage, addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: A 6+ <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). 0 0 <br /> (W), ( T),and drainfield <br /> 2. Show the location of the well se S (DF). v, <br /> septic tank <br /> 3. Show the location of any lake or flowage- if within 1000 ft. and the location of any river or stream- it within o <br /> 300 ft. P ° <br /> 4. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building m m <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 I <br /> dated by the owner. M a <br /> PLOT PLAN v 1 <br /> c c�h vc l�raa)lu( <br /> 0 <br /> a <br /> O <br /> O � <br /> On Pep-(Y,,,-T— Z <br /> 00 M <br /> N <br /> I <br /> o T N m <br /> NN m C C_ <br /> B 0 M <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 /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- f .n m w O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- [ 'm N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 ; $m $ <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- .w <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have ro N o . <br /> access to the above described premises at any reasonable time for the purpose of inspection. i 0 8 N , <br /> m map <br /> SIGN HERE <br /> (signature of owner or i1 g confractor) (date) <br /> ZONING ADMINISTRATOR <br /> ww�ur^wu -n <br /> TOWNSHIP/PERMITS MAY BE REQUIRED N N N N N O O O <br /> $ 88888 <br />