Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the N m <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 Wisconsin. <br /> O (Pleas nnt) Contractor or Surveyor or Agent o <br /> tax '�s D Z71 <br /> AVIress I Address -� <br /> h10.\/VJ@ C cl <br /> City, St te, Zip Code City, State, Zip Code k. <br /> yJ'tsror�tr �4M3 <br /> T lephon Telephone i 1 <br /> Emergency/Fire No. and Road Name -� <br /> Legal Description (as Indicated on tax statement) o <br /> n L7 <br /> Permit(s) Applied for: 0 �- <br /> Dwelling Addition Filling/Grading Camping Unit S <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision o } <br /> Garage (� <br /> Structure Use: Des-K AMC <dw 1 t u rE41Ccte_ NtUC,W�k o <br /> (family home/cabin, garage, addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: C <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). M <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 3 <br /> 3. Show the location of any lake or flowage-if within 1000 ft. and the location of any river or stream-If within o <br /> 300 ft. o a <br /> 4. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building m u, <br /> to lake, river or stream, if applicable. t <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C <br /> dated by the owner. (A <br /> PLOT PLAN See 1!9TJ,Lda6�G I o� <br /> t <br /> m <br /> �� �l3la�IC were_ a�ue slwb 4.�5 �" <br /> /t/o/ ° <br /> // m <br /> 06 '41'yTor IL!/ 1 U� �A6c o <br /> �I <br /> ` Q �5 am oc � mmgna'�'.O <br /> tec�� A ' am m f0 <br /> _. <br /> F °� <br /> o T� i <br /> _ S m <br /> �t moo : O <br /> a 1 C <br /> a� g <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- S m m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- , <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ao o <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I �t 4 $ m $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- <br /> plication. I agree to permit county officials charged with administering county Ordinances or other authorized person to have �, o <br /> access to the above described premises at any reasonable time for the purpose of inspection. w $ m <br /> r i B n <br /> m i V � N <br /> N N QA <br /> a <br /> SIGN HERE . o x <br /> ( 'gnat of ow r building contractor) (date) <br /> ZONING ADMINISTRAT -� <br /> TOWNSHIP PERMITS MAY BE REQUIRED cN N N R 'o - 8 m <br /> $ $ 8 $8 $ 9T <br />