Laserfiche WebLink
l <br /> Burnett f;�junty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ,� 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> z <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- m <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./ o IVC'11 <br /> a o <br /> OWNER(Please Print) contractor or Su eyor or Agent _ <br /> Cn/s s- l verLa � Rd <br /> Address Address <br /> /V <br /> J12, <br /> City, -V <br /> City,State,Zip Code City, State,Zip Code <br /> I <br /> Tel hone Telephone <br /> �ch�(I- 10991 a-SO 'S®' / �1 <br /> Emergency/Fire No. and Road Name &/Zi V) <br /> -- �S'o4rt'h <br /> Legal Description (as indicated on tax statement) <br /> Permit(s)Applied for: 0 O <br /> V0 <br /> New Building Sanitary Filling/Grading Camping Unit 0 -� <br /> r — - <br /> Addition Privy Moving Subdivision o ° / I1 <br /> �q ro a e� Sto�c�c S1 �O "x Y, Z a V <br /> Structure Use: o <br /> (fanlUy home/cabin, garage,typ#of addition,etc.) <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 9 m <br /> Z <br /> P Q _ <br /> a <br /> 5 C <br /> 0 <br /> O <br /> Cry^ J <br /> vl+ <br /> a 11 {1 <br /> 0 <br /> J <br /> 13 <br /> o <br /> J � <br /> pct <br /> M C�md 0aacm <br /> n v< JJOn- m <br /> WCO <br /> N 2 N 0 J p <br /> Z o <br /> o J : <br /> m <br /> o: <br /> O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o I i J : 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 G <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 /> N <br /> SIGN HERE <br /> gnatu of owne Ing contractor) (date) [ c o <br /> ZONING ADMINISTRATOR`— <br /> o: o <br /> TOWNSHIP PERMITS MAY BE REQUIRED �� m <br /> 0000000 <br />