Laserfiche WebLink
i <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; M 0 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3. ' - <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a C� <br /> regulations of the State of Wisconsin. y /� <br /> C <br /> O=ease Printy Contractor or Surveyor or Agent o q <br /> Address // Address � <br /> City, State,Zip Code City,State,Zip Code � Qf <br /> Telephone- RLrele hone <br /> I ' <br /> XrllAP I A lo-(- V <br /> — QR,/� �/ c`� n�'�- ' ��1�,�i cls it�f. �l. i I <br /> E gency/Fire No. and Road Name <br /> } vest / - n I TX101V I q Li <br /> Legal Description (as Indicated on tax statdml r �,� ,x.,; rl - <! r * ,��: Q �. <br /> Pe(q>rF(s),Applled for: <br /> (\ Dwelling 1 Addition _ Filling/Grading Camping Unit o <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision m <br /> Garage } <br /> Structure Use; vC KL r,f Pr e ,i: k r <br /> o�L �W i -T-g,2 (family home/cabin, garage, addition, etc.) <br /> DIRECTIONS FOR PLOT PLA DRAWING: <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). A <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 0 3 <br /> In 3. Show the location of any lake or flowage-if within 1000 ft, and the location of any river or stream - if within P 0 <br /> 300 ft. o a <br /> 4. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building 0 � <br /> to lake, river or stream, if applicable. m or, <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 v <br /> PLOT <br /> PLAN _vJ\ <br /> -, - .co <br /> m <br /> f <br /> l 6i <br /> F6 ro Z <br /> J � y <br /> � 1 <br /> o c bi m o <br /> n <br /> o1E M <br /> o <br /> � �r�A /7X�CY'f6 ^i._h'�du UIQ TJ M <br /> LM�.f� &W"W'/"Z Y`�9+�'tlX�r F . Z5 <br /> J c20� W112 U)r..i , 13'� D'�/Lo,�4f Ckal-dnCe_. N ` me O <br /> Q 8 <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl� 5. : m `� m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. (1:1 8 <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <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 I opo o <br /> access to the above des2cnb d premises at any reasonable timg for the purpose of inspection. w 8 m <br /> m 3 n <br /> SIGN HERE <br /> n <br /> (signature of owner r building,con c r) <br /> ZONING ADMINISTRATOR --__ g '. <br /> Lol <br /> TOW SHIP PERMITS MAY BE REOUIR t f ��In .8 <br /> II 5281 888888881 <br />