Laserfiche WebLink
" ( .) <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m - --I o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and i0 <br /> m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> c <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. m° <br /> f <br /> OWN R (Please Pri t) Contractor or Surveyor or Agent o a <br /> � BAK IKK;Ace <br /> �r{� til wg. MW . �) 1 o Address <br /> City, State, Zipyf <br /> Code City,State,Zip Code 1 C <br /> l - Cl - 5- � q � <br /> Telephone Telephone <br /> Em!rgency/Flre No. and Road Name <br /> N iSrorV NN6, /NI 5 "'T 11 )Q 14 W pct- t//, /C, /J!': e 11P df 15 <br /> Legal Description (as Indicated on tax statement) C-0-L I-#Are /- o'/ K 3 L a r /it g ' <br /> Chi � <br /> Permit(s)Applied for: o <br /> Dwelling Addition Filling/Grading Camping Unh o <br /> z o <br /> Accessory Building Sanitary Privy Subdivision ° Z <br /> Garage <br /> Structure Use: f r, 41 ni a M r/ ' 4r s� e <br /> 0 <br /> (family home/cabin, garage, addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: C <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). A O <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). () 3 <br /> 3. Show the location of any lake or flowage-if within 1000 ft. and the location of any river or stream- if within 11 P d c <br /> 300 ft. an Z v <br /> 4. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building <br /> to lake, river or stream, if applicable. m 0 <br /> C I€ <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 1 <br /> dated by the owner. (R O <br /> m fy� <br /> PLOT PLAN <br /> Cn <br /> A <br /> f/6 o <br /> a4yll Li N m n I6` <br /> J <br /> / = I <br /> XIP �I I <br /> 1• � i' I ` Z <br /> l31 p� o 6- <br /> onn2ro6 $ae9m <br /> , ' <br /> aa�am n C <br /> < ` 1 H o > o 3 <br /> Zo e .Z ro 1 <br /> P T N M <br /> M <br /> g m c C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m A i p <br /> 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- E m a ; O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mationI am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g m g <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.1 agree to permit county officials charged with administering county ordinances or other authorized person to have access«i the above described premises at any reasonable time for the purpose of inspection. m ' 3 8 a <br /> m N A N <br /> (sig ure of owner r building contractor) <br /> NISTRATOR I <br /> TOWNSHIP PERMITS MAY BE REO i b APR <br /> - 81991 <br /> lJ I 88 888 <br />