Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrato c 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <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 /> Bur- <br /> tions of the State of Wisconsin. - <br /> 0 <br /> 1 M d <br /> 4."e orw e Lfa d r,.D •nG ,L�• - Illl, ,�i I ` !� <br /> OWNER(P Contractor or Surveyor or Agent ase Print) Conn r-' n O <br /> A'n,,A ,p £ <br /> .1 Fst er Ai V <br /> Address Address m <br /> / r,t, y M <br /> City,State,Zip Code City, State,Zip Code o' <br /> �2lcF 71d-3ySo 7l5 x59 - 3.257 <br /> Telephone Telephone <br /> 3/0// 7a6o� ,ak L7r�ve <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as indicated on tax statement) o l <br /> Permit(s)AppliedQj <br /> New Building Sanitary Filling/Grading Camping Unit 0 o <br /> Addition <br /> Privy Moving Subdivision 0 o <br /> Structure Use: =C(Omb i m1 se �� ��(�y Z <br /> (family home/cabin, garage,type of addition, etc.) <br /> P ° <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). r- <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 /> PLOT PLAN 3 <br /> a <br /> m <br /> Z c <br /> o a <br /> n <br /> N <br /> O <br /> I J <br /> Vie_ �heo� Draw), N6 <br /> t <br /> I <br /> m <br /> 0 <br /> N H <br /> Z <br /> 31 v)V N f' D W <br /> 0 P< 0 O n�. m <br /> (D 6`G 'n 0 ^i a <br /> ZN : `Z' N O J(O <br /> O O 0 1 <br /> J ? m: 7J <br /> O 0 <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 informs-tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i i c O <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 /> j T <br /> SIGN HERE j_An cA G+-- CJ„,ke a.o-.�- �-- /bia <br /> (si ure of owner o building contract ) (date) ` 'v ' N <br /> ZONING ADMINISTRATOR o o <br /> o: o <br /> l TOWNSHIP PERMITS MAY BE REQUIRED N N o m <br /> o o o o M <br />