Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ,� m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. <br /> w � <br /> Rnheh.t CaUfrm n E <br /> OWNER ((Please P int Contractor or Surveyor or Agent o ! <br /> 15&00 int <br /> m <br /> Address Address <br /> Choctaw, OK 73020 GJ <br /> City, State,Zip Code City,State, Zip Code <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name ` <br /> pancet SW 1/4 NW 1/4 Sec. 33, T39N, R17W, Town ob L(nco !n <br /> Legal Description (as Indicated on tax statement) <br /> n o <br /> Permit(s)Applied for: 0 <br /> a r <br /> Dwelling Addition Filling/Grading Camping Unit ° Q <br /> v <br /> 0 o 1 <br /> Accessory Building Sanitary —X Privy Subdivision P <br /> Garage 6 <br /> Structure Use: SanTtcycN Unto r <br /> (family home/cabin, garage,addition, etc.) tJ' <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> o i,11 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). o <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 93 u <br /> 3. Show dimensions In feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building an Q <br /> measurement to the ordinary high water mark of lake,stream,or river. o n I v <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m S <br /> dated by the owner. <br /> C <br /> PLOT PLAN <br /> PJJ <br /> M <br /> L,U <br /> m <br /> o` <br /> SEE ATTACHED o vl� <br /> = tl <br /> o � <br /> N <br /> �Iv <br /> l� <br /> Z <br /> 9 <br /> o = � m;v Dam <br /> A. Dai aa0 am M <br /> o Fes : TZ . -1 <br /> m <br /> � [ <br /> D01G)Gtr ; O <br /> 8 nom ` C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- c m 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. w ro h a <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- i�m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ A $ <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 n o <br /> access to the above described premises at any reasonable time for the purpose of inspection. $ m <br /> ro 3 A m <br /> SIGN HERE tjade RuAAhotin 3/19/92 « i : t: i <br /> (sl re of ownerpr ilding contractor) (date) o <br /> ZONING ADMINISTRATC S $ <br /> TOWNSHIP PERMITS MAY BE REQUIRED '"VIN 08 ,'o 9 T <br /> $ 8 $ $$ 888CMA <br />