Laserfiche WebLink
n� ryry/1 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratoro I o <br /> APPLICATION FOR — LAND USE — PERMITS3_ <br /> d _ <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and o <br /> N <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. <br /> N <br /> OWNER (Please Print) Contractor or Surveyor or Agent <br /> 97 6"7-V /20_ A <br /> Address h Address <br /> City,State,Zip Code City,State,Zip Code ' <br /> d <br /> Telephone 7/✓� 63.E-- 96 3 9 Telephone I <br /> Emergency/Fire No. and Road Name <br /> Legal Description(as indicated on tax statement) Qy! &or CC, Q o <br /> Permit(s)Applied for: �/,�/t/'6'� [� GlJESU2n1t'T�" C� (,(�7.S1' 0 o <br /> New Building Sanitary Filling/Grading Camping Unit _X_ 3 .`�- <br /> N <br /> Addition Privy Moving Subdivision 5 <br /> Structure Use: -r'rn��� � mU'l Intl)� 0 a 0 <br /> (family home/cabin, garage, type of addition, etc.) <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). 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 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. ct <br /> 0 <br /> PLOT PLAN a N <br /> O <br /> J <br /> o <br /> N � <br /> Z <br /> D <br /> cliAO) <br /> i7 <br /> add >> <br /> m aam <br /> (; APR2 � g: d= 0 nn <br /> Z a' a C O 5 ro <br /> fIIII a: " n 1 <br /> yl9lio i Wi � <br /> A <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of myT rrowl- <br /> edge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all informa- ` Ao 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 <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 p mises at any reasonable time for the purpose of inspection. <br /> T <br /> N <br /> C /719 � <br /> SIGN HERE <br /> (sig a of o r buil g contractor) (date) o o <br /> ZONING ADMINISTRATOR <br /> A -n <br /> ,,� <br /> TOWWNSHIP PERMITS MAY BE REQUIRED 0.cn 0.0.00v, m <br /> (�/✓� <br /> / lw'd r/( �22 i /��/�J/� rt„ `y �A,/�O oogo 00of/1 <br /> �{(f (�/e� 0(Q% [, aLp�^/1�D08/ <br />