Laserfiche WebLink
01 L <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d M 0 0 <br /> .APPLICATION FOR — LAND USE — PERMITS 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m <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- <br /> tions of the State of Wisconsin. <br /> m d <br /> LaDWoa <br /> n o <br /> OWNER(Please Pt) Contractor or Surveyor or Agent o <br /> 22L�_TlT( m <br /> Address Address <br /> o f AC'l iOg/ <br /> City, State,.Zip�C _ City,State,Zip Code <br /> 101)3 - 3 I��c7 <br /> Telephone Telephone <br /> 114 Ke <br /> Emergency/Fire No. and Road Name N <br /> Legal Description(as indicated on tax statement) <br /> Permit(s)Applied for: <br /> 0 <br /> New Building Sanitary Filling/Grading Camping Unit 0 <br /> r <br /> Addition Privy Moving Subdivision o <br /> v <br /> Structure Use: I 0 a <br /> (family ome/cabin, garage,type of addition,etc.) m <br /> _ n <br /> w <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). <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 it. <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 /> 3 <br /> PLOT PLAN a <br /> z � <br /> 0 <br /> 0 <br /> 0 <br /> A-uBch 4 Ac+ ply <br /> ( �I �i �' Z. <br /> S 0 <br /> 0 <br /> o <br /> 3. J <br /> O <br /> /v <br /> Z <br /> C <br /> m c� mw 0 ca. In <br /> n 0' o na <br /> m -' m <br /> n� <br /> m <br /> m 0 (00 3 <br /> Z o: <br /> ° rn: 70 <br /> ai m <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 informa- c 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 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 /> N <br /> SIGN HERE <br /> (sig&rebnerorb'uilditractor) (date) o o <br /> ZONING ADMINISTRATOR A"T 7 o o <br /> a n T <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N o 0 o m <br /> 00000fA <br />