Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratord 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 � N <br /> Ul <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the U t <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. H m <br /> 41)11Z�-I KA€FEa S�L� a = f <br /> O NERlease Print) Contractor or Surveyor or Agent o <br /> _b QU] IKEN-v LK - 120 <br /> Adyg Address <br /> City, State, Zip Coe City, State, Zip Code 70 <br /> Telephone Telephone ) <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as indicated on tax statement) <br /> Q T <br /> Permit(s) Applied for: o °- <br /> '^ r <br /> Dwelling Addition Filling/Grading Camping Unit <br /> v <br /> !�, Z o I <br /> Accessory Building Sanitary Privy Subdivision ° � <br /> Garage -�}7 J��,J p J1 <br /> Structure Use: sicwI "' "I 1 .;T YrTAt�lo/7-1 <br /> (family home/cabin, ga age, dditio , etc.) / <br /> DIRECTIONS FOR PLOT PLAN DRAWING: a <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). O <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). 0 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 P c <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 m <br /> to lake, river or stream, if applicable. M <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and CN I L <br /> dated by the owner. <br /> fn � <br /> PLOT PLAN V <br /> 1t R LEO O <br /> CA <br /> 4 n <br /> ( v � <br /> O <br /> v I� <br /> � h <br /> o V <br /> O � <br /> m <br /> i <br /> 2 <br /> 9 <br /> 0 o c m m o a g m <br /> a aa� ma 'm^ ' m � <br /> C <br /> 2 ui o . m' 3 <br /> Z <br /> a m ,z : 1 <br /> f T � m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 01 ' m r m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- yy!! w w m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 m 8 <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- N <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. ' 0 80In El ` <br /> m A H <br /> m m <br /> N m <br /> SIGN HERE j' n <br /> (signatur owner or build-vig contractor) (date) Fr <br /> o : <br /> ZONING ADMINISTRATOR <br /> �� w <br /> TOWNSHIP PERMITS MAY BE REQUIRED "� ^ £S m <br /> nut ut cnoo <br /> gg ggg gggy <br />