Laserfiche WebLink
Burnett County 7410 Co. Rd. K, #102, Siren, WI 54872 Office of Zoning Administrator d _ 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 H <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- m m <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. o <br /> 4AM6157 MIC1 AEt,sod 0 o <br /> � Ibo--OWNER(Please 4ZPrint)/�n Contractor or Surveyor or Agent <br /> ST 0 <br /> m <br /> AQdHuDressso nl ( O� b Address <br /> City,Stade City,State,Zip Code <br /> _7!S Z X7461 - lot 5 7 <br /> Telepho a Telephone <br /> Permit(s)Applied for: <br /> New Buildings Filling/Grading <br /> Addition Moving X o <br /> Sanitary Camping Unit o <br /> Privy Subdivision 0 <br /> r <br /> o <br /> Structure Use:FAMI1 Y r7UMMKrz_ CA5ik <br /> (family homelcabin, garage,addition,etc.) o w` <br /> m 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). <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. o <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, <br /> 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. F Prnui ria 1Pna1 1Pnri riperr ipf i nn p <br /> 0 <br /> PLOT PLAN 3 <br /> v m <br /> 5q i �Llll� n <br /> J <br /> o t � <br /> oa rn <br /> o <br /> / <br /> / '� / <br /> ' N <br /> 0 <br /> u � <br /> I /?. <br /> m 6 w T <br /> p Z <br /> i � 64 <br /> 3 V 7 SI l V% �) D <br /> / y <br /> (h l08( � lOg r 7b <br /> �T N <br /> i' <br /> []� C N8ol SI W <br /> [ <br /> 7J fn l7 tnr DD[D� <br /> MI61'L­ 0 a<> > n aE.m <br /> /L.�p/(yy� m arc =a m <br /> i OCT 1 61 {� Q -5 m : zN0 , <br /> (�, y�� 117 �,�(/� ��at> I o <br /> Li VL �--1 „ 7 �' Y L� �I S <br /> «: m <br /> o c C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my _ <br /> knowledge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all m <br /> > <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that O <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a o <br /> permit.I further accept all liability which may be a result of the County of Burnett relying on this information I am providing m <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized n <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> m <br /> m <br /> SIGN HER <br /> (sl <br /> to of ownertb contractor) (date) o o <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS AY BE REQUIRED NNO J Nm <br /> NN(!•tTOON <br /> 0 0 0 0 0 0 0 Vl <br />