Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratorw o / o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m 1 <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m c - <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 n <br /> tions of the State of Wisconsin. m <br /> nW'\\' V Vr-x,)(Qy\ C�Ct S m <br /> 0 0 <br /> OER(Pleas rent) Contractor or Surveyor or Agent n £ <br /> "abb reo. 1' o <br /> drG�O�,e\ <br /> U0-T_ 44� b Address �° U1 <br /> i <br /> Lp <br /> City,State,Zip Code City,State,Zip Code <br /> Telephone Telephone <br /> ► --I 15 - 35R-15x3 d <br /> Emergency/Fire No. and Road N <br /> Legal Description (as indicated on tax statement) p <br /> Permit(s)Applied for: o <br /> New Building X Sanitary Filling/Grading Camping Unit 0 .`.- <br /> r <br /> Addition Privy Moving Subdivision $ o <br /> ° <br /> 1 f3 IQ 2 J ��O YttGIG]-Q a <br /> Z o <br /> Structure Use: 6 km <br /> (family h elcabin, garage,addition, etc.) 1 <br /> 7 <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). r <br /> 2. Show the location of the well(W) septic tank(ST),and drainfield(DF). <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 lake, C <br /> river or stream, If applicable. X <br /> O <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and dated by o <br /> the owner. 3 <br /> 9 a N <br /> PLOT PLAN Z <br /> o a <br /> SCC a _ <br /> M U <br /> U <br /> s <br /> N <br /> m <br /> m <br /> 0 <br /> m <br /> M V) (n r D D coy <br /> ; <br /> w o .2 <br /> m <br /> 'Vh� Gfo O <br /> "fig: <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 informs- >: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- O v 2i 8 <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 maybe 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. 0^ <br /> SIGN HERE <br /> (si re wner or building contractor) (date) ` o <br /> o: <br /> ZONING ADMINISTRATOR -c. <br /> HiA��rA��y <br /> �vNi��oo�im <br /> TOWNSHIP PERMI S MAY BE REQUIRED 888888$ai <br />