Laserfiche WebLink
Burnett County 7410 Co. Rd. K. , 1102, Siren, W1 54872 Office of Zoning Administrator Z <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 'z <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 C <br /> tions of the State of Wisconsin. <br /> L- 1fr'e�eh y o <br /> o�✓NE2 = <br /> OWNER(Please Print) ii O <br /> Contractor or Surveyor or Agent F <br /> Address Address <br /> [.LJr� c-�e c. w,' f5<PY3 <br /> City,State,Zip Code r City,State,Zip Code <br /> G <br /> Telephone Telephone <br /> Permit(s)Applied for: <br /> New Building _ Filling/Grading �- <br /> Addition Moving <br /> 0 <br /> Sanitary Camping Unit <br /> Privy Subdivision o <br /> J <br /> yam' ^ U w ( <br /> Structure Use: a ��K-o..a 12— 5 Pf U \ X D 1 f S .or• <br /> (family home/cabin,garage, addition, etc.) z <br /> ° <br /> m <br /> Directions for plot plan drawing: o � <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. o <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 fake, <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 /> PLOT PLAN o <br /> 3 <br /> v to <br /> a ((cam Z = <br /> o a <br /> 1 0 <br /> yl <br /> t <br /> �o U.rS O O <br /> Ch <br /> t <br /> f ld° o „JQ,ll o <br /> ----. o <br /> J <br /> Q N <br /> 4-- /0 GLral \ <br /> o � <br /> A/eA/ <br /> _10f alL9 F4,l <br /> p `�( Z <br /> fl o <br /> Z <br /> I <br /> Q / D mv(nr DDW� <br /> lrC SIQIa<'> > n a= <br /> Lb. L.� =C.m =aW <br /> °c 'oo='3 <br /> m a � 0 <br /> o Z o: <br /> �` m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all ° m i <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that A m <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a <br /> permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am providing <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized a <br /> person to have access to a above descri d prepises at any reasonable time for the purpose of inspection. <br /> m : <br /> ry <br /> — 7 -8 �SIGN HERE <br /> gn ure of own building contractor) (date) <br /> ZONING ADMINISTRATO o`: <br /> o: o <br /> TOWNSHIP PE MITS MAY BE REQUIRED NT NT N N O <br /> 00000' <br /> 00000 <br />