Laserfiche WebLink
Burnett Co)jnty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w - o 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 y <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the C% <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. CD <br /> y <br /> Daniel W. Gaither Donald Daniels a = ( o <br /> f <br /> OWNEFL(PLeaneCPriin) Cc t1acto0rorgyrrveyororAgent o <br /> 11���y�� FP8 ttii 3311 m <br /> m <br /> Address Address <br /> St. Paul , MN 55105 Siren, WI 54872 — <br /> City, State,Zip Code City, State, Zip Code CJ <br /> 612-224-4525 715-349-5533 <br /> Tell;phpDe- 6444 Hwy 70 E. Telephone <br /> b444U L <br /> Emergency/Fire No. and Road Name <br /> Pcl in GL 3 & 4 Lots # 1 ,2,3 S35 T39N R16W Meenon Township Q <br /> Legal Description (as Indicated on tax statement) <br /> o Z <br /> Permit(s)Applied for: 0 <br /> r <br /> Dwelling Addition Filling/Grading Camping Unit <br /> v <br /> 0 o w <br /> Accessory Building Sanitary X Privy Subdivision m Q, <br /> Garage <br /> Structure Use: On I l <br /> (f mily home/ca in, garage, addition, etc.) _ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: o r ) <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). m w <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 3 v, <br /> 3. Show the location of any lake or flowage- if within 1000 ft. and the location of any river or stream-if withinon <br /> 300 ft. o n <br /> 4. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building m u, <br /> to 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 C <br /> dated by the owner. m a S <br /> PLOT PLAN <br /> l <br /> See State approved plan C <br /> p o <br /> w <br /> O <br /> m � <br /> o <br /> I Z <br /> Is <br /> D o W-a m r Dao M <br /> m - a� 3:: a m <br /> go M <br /> v 2 5 ' 0 S . 3 <br /> oZ F ? T� M <br /> m <br /> u ; r O <br /> S <br /> 0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- � S : In <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all inform a- m N O <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. 8 m 8 <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 o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 3 8 0 <br /> 3/l� A �1�, <br /> SIGN HERS r= <br /> (signature f owner p building contractor) (date) <br /> ADMINISTRATOR ) <br /> 0 M M N!A dl T <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> tli UtN NN OO <br /> 8888888N <br />