Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator „ � 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 Bur- m c (�) <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 ntX? <br /> tions of the State of Wisconsin. OF p O <br /> Tames l-v' ✓ yei- - Se- <br /> OWNER(Please Print) u Contractor or Surveyor or Agent n £ <br /> Address Address <br /> Mels M1nr7 <br /> City,State,Zip Code City,State,Zip Code <br /> 1 ria . 'S`/°/9 <br /> Telephone Telephone <br /> a4_9R- F <br /> m <br /> Eergency/Fire No. and Road Name <br /> r <br /> ,..� ` <br /> Legal Description(as indicated on tax statement) p r <br /> m <br /> Permit(s)Applied for: 0 <br /> 0 <br /> New BuildingSanitary Filling/Grading Camping Unit <br /> Addition Privy Moving Subdivision g 0 V <br /> . <br /> Structure Use: r' �.r '- "•9£ K;L J.2 az o <br /> (family home/cabin, garage, type of addition, etc.) o m <br /> Directions for plot plan drawing: <br /> t.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 ordi- <br /> nary high water mark of lake, river or stream, if applicable. <br /> S. If,separate plans are submitted by an architect,engineer, builder,contractor,etc.,the plans must be signed and dated by <br /> the owner. 0 <br /> 0 <br /> PLOT PLAN /.{� a <br /> z c <br /> Jll1 P a ff <br /> uric ^{ S <br /> 1v H <br /> n O <br /> ( -7 ab° <br /> 1/ I <br /> LA <br /> P4 <br /> rt _ _ + o I <br /> O <br /> Lam— <br /> R <br /> I D <br /> (3aO --- <br /> . .-.._--_ a a <br /> Z w 2 o <br /> m <br /> m <br /> Co@ _ <br /> PP (including Yaccompanying ) Y y <br /> I declare that this application includin an schedule has been examined b me and to the best of m knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- Q� o 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. `� <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- <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. <br /> T <br /> m <br /> SIGN HERE <br /> net re of o ner or ng contractor) (date) o o <br /> ZONING AD INISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED NN�TN N m <br /> 00000fA <br />