Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Adr{linistratoro 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d a <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Z2 w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 r1 <br /> regulations of the State of Wisconsin. H m ) <br /> �o tvs_Y• 44pa, C o <br /> NER lease Print) Contra or or Surveyor or Agent o <br /> Addre s ((� Address <br /> CCf <br /> n. 'PY 0811 A) . SSI 57 <br /> City,State,Zip COAS City, State,Zip Code <br /> /n/2/ 34y[n12D <br /> Telephone I Telephone <br /> FLV <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as Indicated on tifif Wement) V 9o <br /> �3urntll- G`Fr. <br /> 0 <br /> Permit(s)Applied for: o 0 <br /> 0 <br /> Dwelling _ Addition Filling/Grading Camping Unit o °^ <br /> v <br /> 0 a <br /> Accessory Building Sanitary Privy Subdivision ° ^ 1 <br /> Garage <br /> a a8 x _ d w <br /> Structure Use: r <br /> o <br /> (family home/cabin,garage,addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate orth (N). <br /> 2. Show the location of the well (W),septic tank(ST),and drainf laid (DF). 3 <br /> 3. Show dimensions In feet of the following:(a) building to all lot lines,(b)building to center line of too (c)building Z <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must b signed and 0 y <br /> dated by the owner. <br /> C <br /> PLOT PLAN fA _ (� <br /> Ind e "' �s <br /> 'T ��.� mf ✓101.<J <br /> P �5 �trlft,d I' is I(j <br /> 4ArOCPfS �^ <br /> + ; C <br /> H /40 a" -a <br /> tASA0 I J4 <br /> t r � 1. <br /> Z <br /> 7 A A 70 <br /> I o, <br /> P <br /> N m C N 7 <br /> MR. <br /> Z Z 3 <br /> �axcJ?t p ��K /VJ f/N Gil �� < a : r <br /> J g nS@ t <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the be t of my knowl- CA [ m E : <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accurac of all informs- a m t <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 8 m 8 <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 Qotffgy officials charged with administering county ordinances or other authorized person to have u, <br /> access to the above ed Oremises at any reason time for the purpose of inspection. m 8 <br /> B € i A <br /> SIGN HERE �' a <br /> (s' tur owns ilding contractor) Ida e) e [ <br /> ZONING ADMINISTRAT g '. ? ;Ak <br /> Y N <br /> TOWNSHIP PERMITS MAY BE REQUIRED 08 00 1 <br /> 88888881 <br />