Laserfiche WebLink
InA e y <br /> Burnett County 7416 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d b <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 2 w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the '^ m <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State <br /> ofppWisconsin. <br /> OWNER (Please Print) Contractor or Surveyor or Agent o <br /> (P Lttod A-ti-e m <br /> Address Address <br /> S7 (SOL , VVJh SSfUt/ Z � <br /> City, State, Zip Code City, State,Zip Code -I t <br /> �0 16 VV— //' 1 <br /> Telephone Telephone <br /> SCGz 00 r <br /> (o -71 <br /> g0U4V j <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as Indicated on tax statement) b <br /> Permit(s)Applied for: o ° (n <br /> � � p <br /> m r S <br /> Dwelling Addition Filling/Grading Camping Unit E; °^ <br /> v <br /> z o <br /> Accessory Building Sanitary — Privy Subdivision o <br /> Garage <br /> Structure Use: <br /> (f miry home/cabin, garage, addition, .. .) y o <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 North (N). 0 <br /> 2. Show the location of the well (W),septic tank(Sl), and drainfield (DF). a3 N <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building Z `c <br /> measurement to the ordinary high water mark of lake,stream,or river. o (1 n <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. C 1 <br /> C _0 <br /> PLOT PLAN m n <br /> S -C A ,a� P/� PcA� <br /> ) m <br /> Yr <br /> QN y <br /> } <br /> 0 <br /> >(y' <br /> N I'IJ <br /> O y <br /> 41. <br /> C4 <br /> r Z <br /> t� <br /> 1 0 X <br /> O <br /> eA <br /> z <br /> oc � nmoa m <br /> n <br /> dry 7] <br /> M <br /> G) m <br /> G) o <br /> 'm g : c <br /> g m 3 : € 9 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know,. <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- H m O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- m cn <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue apermit. I $ 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 county officials charged with administering county ordinances or other authorized person to have Opo : <br /> access to the above described premises at any reasonable time for the purpose of inspection. : m $ m <br /> m 3 A n <br /> x <br /> m R >p H <br /> M N 8: <br /> SIGN HERE `j 0 <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR 71M <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 888 8888u) <br />