Laserfiche WebLink
rr �_ ( E°)-y I ( ' <br /> Burnett C-)unty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator C T 0 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 m 0— <br /> located <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 <br /> tions of the State of Wisconsin. 'p \ <br /> N d <br /> C <br /> FNERi � <br /> (Please P t) Contractrvyo <br /> i4 , ar r � ao 'or <br /> o 0.ill s <br /> ares Address <br /> ► f �� < 37 <br /> C <br /> (iytyl,State,Zip Code Citty�State,Zip Code <br /> V'Yn n.'�s b ra Zv i r �`�P'f O C,rranks�vr Ire 5�5�8�/O �^ <br /> Telephone-ass, Telephone <br /> s ; 4ry <br /> Em e gency n/Faire No. and Road Name <br /> IM ?7 64,4 SHor� D"'yc.- <br /> Legal Description (as indicated on tax statement) o <br /> Permit(s)Applied for: O <br /> 0 <br /> New Building Sanitary Filling/Grading Camping Unit 0 .<..- <br /> N <br /> Addition Privy Moving Subdivision o 0 <br /> �IVlne 0.r cq � <br /> Structure Use: `�" nor`e.h . (y Yay o o' <br /> (famil omelcabin, garage, type of addition,etc.) m <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. n <br /> 0 <br /> 3 <br /> PLOT PLAN ? m <br /> Z = <br /> 0 n <br /> w 0 <br /> o_ <br /> See MactwJ <br /> �j v <br /> 0 <br /> 0 <br /> o <br /> U. <br /> J <br /> Z <br /> G <br /> 0 C m m 0 ac <br /> m <br /> zi i <br /> p <br /> o <br /> o C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 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- $[ [ m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. ) ' G <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I i P <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 /> N <br /> SIGN HERE J/-a 2— <br /> (sign a ownr too ding contractor (date) <br /> ZONING ADMINISTRATOR S 1 I�JY� <br /> _nom <br /> TOWNSHIP PERMITS MAY BE REQUIRED ANN oN m <br /> �0000 0 <br /> 0000 o Cn <br />