Laserfiche WebLink
N <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator to 1 o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> d o <br /> TO TkIE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and m <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 a <br /> tions of the State of Wisconsin. m o <br /> QFA2n)IS jZ SELL V <br /> m o <br /> OWNER(Please Print) Contractor or Su ry r or Agen <br /> Address Address g <br /> Cit State,Zip Code City,State,Zip ode • <br /> L), �/17 F V_ lR7l S c <br /> Tel hone pp Telephone I C\ <br /> /N ' <br /> o.and Road Name YekN� R / I <br /> Emergency/Fire <br /> Legal Description(as indicated on tax statement) orcl. <br /> 0 <br /> Permit(s)Applied for: o <br /> New Building Sanitary FillinglGrading Camping Unit .`�- <br /> r <br /> Addition Privy Moving Subdivision o 0 <br /> v <br /> z o <br /> Structure Use: P <br /> (family home/cabin,garage,addition,etc.) <br /> Directions for plot plan drawing: J <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). <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. C <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, C <br /> river or stream, if applicable. 31 <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and dated byO o <br /> the owner. <br /> 11a m <br /> PLOT PLAN �_ z v <br /> ,L) nl 1 -mak / 303 M u w =n <br /> J V <br /> C <br /> N <br /> r� 0 <br /> ��y \ 0 <br /> Q <br /> rJ <br /> w <br /> ';C" UL �� <br /> -75 fp05�-' <br /> M tov W r DDcoy <br /> m Uom '�ag % Bacm <br /> 0 n --am nag <br /> y w o on <br /> TI in <br /> m <br /> 0 <br /> g m c C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 5: ; E <br /> edge and belief It is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- ? m <br /> (including Yaccompanying ) 9 <br /> tion contained in this application mcludin an schedule and I further declare that I recognize that this infor- O <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I { L� <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 abov described premises at any reasonable time for the purpose of inspection. I E O^ <br /> m : $ <br /> m019N7: <br /> SIGN HERE bi <br /> w $: '• <br /> (signature of own or building co r or) ( ate) 0 o <br /> ZONING ADMINISTRATOR <br /> HHS �HHT <br /> TOWNSHIP PER I S MAY BE REQUIRED Nn Minn <br /> �m <br /> $$ 888th <br />