Laserfiche WebLink
CSI \ C (_;7 ) � <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m �� 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> a s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with .he requirements of the Bur- m 6 <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 a r ^ <br /> tions of the State of Isconsin. w o V 1 <br /> N <br /> OWNER(Please Print) Contractor or Surveyor or Arent n f <br /> Address Address 1 <br /> City,State,Zip Code City, State,Zip Code <br /> T,eylepho�°°eevvrr..���� Telephone n <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as indicated on tax statement) o <br /> Permits)Applied for: 2O <br /> 0 <br /> New Building Sanitary Filling/Grading Camping Unit 5' <br /> .`.- <br /> Addition Privy Moving Subdivision o <br /> V <br /> Structure Use: o ° <br /> (family home/cabin, 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). <br /> 2. Show the location of the well (W),septic tank(ST), and drainfield (DF). .°r. <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. O <br /> 3 <br /> 3 <br /> PLOT PLAN a m <br /> Z <br /> y <br /> S o <br /> ZOZ-+A- X ?Z} — A CJ/u- t_ <br /> LLu <br /> o I� <br /> ��t� Mo�`I � <br /> o <br /> IJ <br /> N y �/ <br /> Iry(� <br /> J <br /> O <br /> N I1rl�N�,rI(1 <br /> Z <br /> / 7J <br /> I� <br /> IEOY [ <br /> MAY 'r 41990 <br /> k l3Lf' 9 1.U v" CQ"p'Yl 1 9 nuc y a y� <br /> � Mm3 <br /> z m 1 <br /> Hopi nc o <br /> . <br /> � So C ;,..2 ice; m <br /> `JE Q rL1l t�al e y Sim{l ' �S) 1/t o f E :.-o . : O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I J i :tea <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 c ty officials charged with administering county ordinances or other authorized person to have <br /> access to the above des premises at r selepme for the purpose of inspection. <br /> m O:ln <br /> �a N <br /> SIGN HERE " <br /> (sig at re of owner uilding contractor) (date) cao0 <br /> ZONING ADMINISTRATOR �� ' 01° ' " o <br /> � , <br /> n n)i pv-n <br /> TOWNSHIP PERMITS MAY BE REQUIRED �o$oN oafm/t <br />