Laserfiche WebLink
Burnett County 7410 Co. Rd. K, ¥102, Siren, WI 54872 Office of Zoning Administrator W v z <br /> ° 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> o s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 'z m <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m <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 /> L/'9'�"f X S �/ .�f1lL ER .f�R n o <br /> 9�9 <br /> OWNER(Please� Print) Contractor or Surveyor or Agent o J J <br /> t <br /> Address Address <br /> City,State,Zip Code City,State,Zip Code <br /> Telephone Telephone <br /> Permit(s)Applied for <br /> i <br /> New Building Filling/Grading <br /> Addition Moving o <br /> Sanitary Camping Unit 0 O . <br /> 0 <br /> Privy Subdivision 0 <br /> r l� <br /> .ST�r�vP SrtED 1`�' )c1L' - A�rQ `6 *n QIrs 13 a <br /> Structure Use: "�/ v <br /> (family home/cabin,garage,addition,etc.) o e° <br /> Directions for plot plan drawing: .� <br /> i <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, t5 <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 n <br /> the owner. Pro - ,�L� 1 'on. p <br /> PLOT PLANPOri /rye' LAf - !=)�'-Iuesn .U,-1P/va ,3 �i y <br /> L qr-c- z a <br /> o a <br /> / O <br /> [� y <br /> 1 � J <br /> a <br /> P <br /> do$' <br /> a" <br /> t ( r <br /> 0 <br /> Ill � V � lig <br /> V <br /> J ° <br /> R. <br /> / ° <br /> R. <br /> S / m <br /> 54e m <br /> CJ <br /> z <br /> saga ti� �' Z� so <br /> �aus(f c} <br /> fo;/9 c 4 C <br /> a < ' C ° o <br /> w '� � o J�o3 <br /> o <br /> 0 o: <br /> N: M <br /> m <br /> O o: <br /> declare that this application (including any accompanying schedule) has been examined by m and to the best of my 0: A <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the de it and accuracy of all m <br /> PP (including Yaccompanying ) g n <br /> information contained in this application includin an schedule and I further declare that 1 recognize that <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a : 0 <br /> o : <br /> permit.I further accept all liability which may be a result of the County of Burnell relying on this information I am providing jy <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized ` n <br /> person to have access to the above describe4 premises at any reasonable time for the purpose of inspection. <br /> T <br /> Q tD <br /> SIGN HERE <br /> is At owner o ding contractor) (date) <br /> ZONINGINISTRATOr R <br /> TOWNSHIP PERMITS MAY BE REQUIRED UNNO V Nm <br /> 0000 00 <br /> 0000 ooV7 <br />