Laserfiche WebLink
C) IN C-0 M <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratoro 0 <br /> '- <br /> APPLICATION FOR — LAND USE — PERMITS w 3 <br /> TO THE zON;.NG ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 6 �n <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur. .0 00 <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. <br /> ��* n <br /> OWNER(Please Print^ is Contractor or Surveyor or Agent n O <br /> S:N n C_ <br /> AddressAddress '"' CA <br /> 1_0\ C( `6 -) <br /> City,Sate,Zip Code City,State,Zip Code <br /> �- �Z -ZS2_ cP I� <br /> Telephone� 2 Telephone ��c t✓ <br /> Emergency/Fire No. and Road Name n -� <br /> Legal Description(as indicated on tax statement) o f� <br /> Permit(s)Applied for: r/1 <br /> o Y <br /> New Building Sanitary Filling/Grading Camping Unit <br /> N <br /> Addition Privy Moving / ubdivision g % <br /> ( °, <br /> Structure Use: �� l Q q aq X ZUt 0 0 <br /> (family homelcabin, garage,type o dition, etc.) o <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). <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 /> 5. If,separate plans are submitted by an architect,engineer, builder,contractor,etc.,the plans must be signed and dated by <br /> the owner. O <br /> 0 <br /> PLOT PLAN 3 <br /> Z P <br /> sl�.Q cz.A�Q c'l-' C. n <br /> O <br /> 0 <br /> i <br /> 6 <br /> J G u, <br /> ) <br /> 0 <br /> � I <br /> N 1,_ <br /> 0 <br /> 7 C <br /> O <br /> O <br /> N �-I <br /> 1 Z <br /> 0 a< m <br /> m n� -•nm -;ate <br /> 00 o S 3 <br /> Z ioi `i o �m <br /> 2v i Tli <br /> fT: :V, O <br /> 1 declare that this application(including an accompanyingschedule has been examined b me and to the best of m knowl- z'0 :o; <br /> PP ( 9 Y ) Y Y �o: i , y <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- — i 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 a E <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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. - <br /> m of <br /> SIGN HERE `�' `• <br /> $i atur of owner ding contractor <br /> ( ) (date) <br /> ZONING ADMINISTRATOR ice . ; oyo <br /> ki'l b4 "n <br /> NNOiJ ��" m <br /> TOWNSHIP PERMITS MAY BE REQUIRED "Ppm <br /> 000000 <br /> 0000 oS� Vl <br />