Laserfiche WebLink
durnetf County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning AdministratorM 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 <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. 3 a ( <br /> tions of the State of Wisconsin. o <br /> ] vihc. E6,Kswt- Sr <br /> OWNER(Please Print) Contractor or Surveyor or Agent n- <br /> �9aS'l r s /Ly• oklC <br /> Address Address <br /> i/A'Pl. 6 u rY4 tAf jmm f v✓V. S� q <br /> City,State,Zip Code City, State,Zip Code <br /> X__ � <br /> Telephone nO Telephone — <br /> �9�5'i Lcfn � <br /> Emergency/Fire No. and Road arae <br /> Legal Description (as indicated on tax statement) o <br /> Permit(s)Applied for: @ <br /> Y o Z <br /> New Building ?� Sanitary Filling/Grading Camping Unit m <br /> Addition �Privy ' A —7 Moving Subdivision o .°r, J <br /> J/O f•�6-C, Ste/. / to 9-� ' <br /> Structure Use: Z � <br /> 0 <br /> (family home/cabin, garage, type of addition, etc.) <br /> `c <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. 0 <br /> 0 <br /> 3 <br /> PLOT PLAN o <br /> Z <br /> o Q <br /> n <br /> 0 <br /> l4" <br /> t <br /> a <br /> 0 <br /> a <br /> sew N <br /> o ° <br /> o J <br /> C N IIS <br /> ` ^ I <br /> �n <br /> Z <br /> r <br /> �/ 7p Nv(nr DDWm <br /> 9a m nom ' am aa � <br /> Mn <br /> m j � o m <br /> 0 0: : <br /> n a LAA- <br /> ISO r v �, N: m <br /> ^i ��J N: : :YC ?J, O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o V F) 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- n o: m <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 'c <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 count officials charged with administering count ordinances or other authorized person to have <br /> P� 9 P Y 9 9 Y P <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> T N: <br /> m an; <br /> _ 19- 90 <br /> SIGN HERE 'nD. <br /> m o; <br /> (si at a of o r buil g contractor) (date) in <br /> o <br /> ZONING ADMINISTRATOR : = opro: Fo <br /> NNON � gm <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> 000000 <br /> 000000 (1) <br />