Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o a <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descr0 <br /> ibed and m <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 3 <br /> regulations of the State of Wisconsin, o <br /> N � <br /> � <br /> N�nn,s Dwom E 0-son a o <br /> OWNER (Please Print) Contractor or Surveyor or Agent o <br /> 3fg C)XF:o60 GIiZCLE <br /> Address <br /> Address p <br /> 14.,oo06L,A ytd )A/A/ -S-S-12-S <br /> City, State, Zi1�CoQde City, State,Zip Code (6 <br /> �foMG �jaJ73%-!776 1NaR1c �,li-�773-573Y <br /> Telephone Telephone <br /> /, 4E /{oovEy LftkE hgvl+D (n <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as indicated on tax statement) o <br /> Permit(s)Applied for: o` <br /> c <br /> Dwelling Addition Filling/Grading Camping Unit o <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision q g I, <br /> Garage l / <br /> � _71 <br /> —L <br /> Structure Use: c,a r ^ r dd 1 011, <br /> r <br /> 0 <br /> (family home/cabin, garage, addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: 0 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). M 0 <br /> 2. Show the location of the well (W),septic tank (ST), and tlrainfield (DF). C 3 <br /> 3. Show the location of any lake or flowage-if within 1000 ft. and the location of any river or stream- if within P m <br /> 300 ft. z v <br /> o a <br /> 4. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building n <br /> to lake, river or stream, if applicable. 111 o <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C <br /> dated by the owner. m <br /> PLOT PLAN <br /> Sf rz 7'fv � L rac <br /> 9) <br /> O <br /> N <br /> O <br /> m <br /> O <br /> w' <br /> z <br /> I A <br /> 2.- <br /> m w o a <br /> m <br /> am_ p1 c03 <br /> z mp ? m ,°ZHo"° 1 <br /> F T y M <br /> m <br /> g c : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m a <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 /> 9 P 9 P Y <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 82 N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g m g <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 i <br /> access to the a o described premises at any reasonable time for the purpose of inspection. y0 <br /> N 3 g w <br /> SIGN HERE <br /> (sign8lu a of own building contractor) a)- <br /> II 1= of o . x ; . <br /> ZONING ADMINISTRATOR : g <br /> r . <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> m <br /> 8sa8 cma <br />