Laserfiche WebLink
b__.., r "'," <br /> Burnett County 7410 Co. Rd. K, #102, Siren, WI 54872 Office of Zoning Administrator m 'a o 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 uJ <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m c (\ <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. = o <br /> ��--++ N d <br /> S RO t/ L j?V_ CJ 1< d4. YYl f' n O <br /> O NER(Please rint) Contractor or Surveyor or Agent <br /> 171 c3, Rn a' 73 ° "- <br /> w <br /> m t <br /> Addre s Address <br /> ,S 7 ro f X �2//.s 5�oa S� <br /> City,State,Zip Coe City,State,Zip Code <br /> 7/s- 1't3 /P3/ OG 56 - Ule <br /> Telephone Telephone <br /> Permit(s)Applied for. <br /> New Building Filling/Grading <br /> Addition Moving v <br /> Sanitary Camping Unit o c1 <br /> o <br /> Privy Subdivision 0 <br /> v, r <br /> Structure Use: e L lr <br /> (family homelcabin,garage,addition,etc.) o 0 <br /> m <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 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 lake, <br /> 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. 6. Provide legal land description. <br /> 0 <br /> PLOT PLAN 3 <br /> 'R n, <br /> Z v <br /> o n <br /> y <br /> Q. O <br /> J <br /> 1. <br /> c�N <br /> �i <br /> 0 <br /> G� o <br /> J <br /> J <br /> O <br /> O <br /> Z <br /> Z <br /> O <br /> � Z <br /> 9 <br /> my nr D <br /> 0 cr<M 0 n <br /> a y o 0 3 <br /> m <br /> m <br /> o c C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all — m <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that a O <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a <br /> o : <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing v, <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> N <br /> SIGN HERE <br /> (sl re of own ui Id ing contractor) (date) o o <br /> ZONING ADMINISTRATOR f'/ o0 <br /> /� � w-n <br /> \YNIJGIJ <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> u .a p,u,. o <br /> 0000fA <br />