Laserfiche WebLink
cC"N'T . <br /> Burnett County 7410 Cor-Rd. K;No. 102, Siren, W154872 Office of Zoning Administrator d o 0 <br /> APPLICATION-FOR — LAND USE — PERMITS3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 'Z y ll ' <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 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 Wiscons' y o <br /> 14Obiler a Q-) o <br /> OWNER (Pleas Print) yy-- Contractor or S7yol1r or Agent r o _ <br /> .$IXC✓e 4- c ACSo n/ SW Lr t�f!—ro <br /> Address PJ Address <br /> City, State, Zip Code ' City, StecZ�Code <br /> Telepho Telephone <br /> ( Id - '��oZ - 4 Fa o 7/J'- V7 -4 - 2 73 ir— <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as indicated on tax statement) o <br /> Permit(s) Applied for: o 0 <br /> J <br /> Dwelling Addition Filling/Grading Camping Unit o <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision ° — <br /> Garage4-1 <br /> Structure Use: <br /> (fafnily home/cabin, garage, addition, etc.) <br /> r o <br /> 1 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: � <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). Q o <br /> 3. Show the location of any lake or flowage- if within 1000 ft. and the location of any river or stream- if within on a N� <br /> 300 ft. 0111 Z Q_ <br /> � <br /> 4. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road, (c)building .o a� 5 �- <br /> to lake, river or stream, if applicable. m o <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C ' J <br /> dated by the owner. to C-- <br /> PLOT <br /> PLOT PLAN J <br /> D <br /> Q <br /> WSUm <br /> n <br /> 0 <br /> N <br /> 0 <br /> J <br /> m <br /> v � <br /> Z <br /> � z <br /> AIvr ll' -- -* °. F 2 a m <br /> m. Dnp . am ama <br /> O < Z' `z N O J m �_ <br /> 0 N o � .2 : <br /> f J T NZJ <br /> M <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best ofmy know, � m M <br /> 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- d, m m M <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- a <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I- <br /> 9 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. I agree to permit county officials charged with administering county ordinances or other authorized person to have ro <br /> access to the above described remises at any reasonable time for the purpose of inspection. m N <br /> m 3 <br /> 8n : <br /> n <br /> SIGN HERE 8 ` <br /> (signature of owner or building contractor) (date) � <br /> a <br /> ZONING ADMINISTRA OR :TAn, T Y -866&-113 g I I <br /> TOWNSHIP PERMITS MAY BE REQUIREDu ^� N o o m <br /> gg 8 rmn <br />