Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> o h <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m r, <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m m l <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. o <br /> OWNER(Please Print) Contractor or Surveyor or Agent a J F <br /> Address Address <br /> City,State,Zip Code City,State,Zip Code <br /> Telephone Telephone <br /> 791 A aoA1 J P,40= <br /> Emergency/Fire No. and Road Name <br /> �'-V S-0A soy/�yc/ is 1061 #/s o/ c i6oa M u✓�/sem <br /> Legal Description (as indicated on tax statemento <br /> Permit(s)Applied for: n G) <br /> 0 <br /> New Building 'Y' Sanitary Filling/Grading Camping Unit .`..- <br /> N <br /> Addition Privy Moving Subdivision g <br /> v <br /> Structure Use: �,Ai2��F o 0 <br /> (family home/cabin, garage, type of addition,etc.) o <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). o <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 /> o a <br /> PLOT PLAN � ' 13 <br /> r N <br /> 0 <br /> TIV,716 r <br /> 0» <br /> ' I <br /> U o <br /> 9 � <br /> jE-t_ j n Karma 'rJ <br /> "-si,u <br /> co-0CorDDco -0 <br /> M c .Mw 0 a c m <br /> n a< 0 = 0 a- <br /> m a, 'am ^;nM <br /> w 'Zuf p �m <br /> 0 0 : m z <br /> m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o: 0 : y <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- o 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 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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> T : <br /> SIGN HERE <br /> (si atur of owner or buil contractor) (date) <br /> ZONING ADMINISTRATOR <br /> T <br /> TOWNSHIP PERMITS MAY BE REQUIRED N u c N N <br /> fP(T(TN O (T <br />