Laserfiche WebLink
, ,��// <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o c <br /> APPLICATION FOR — LAND USE — PERMITS 3. ' <br /> d s <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. w d <br /> '' 11e4Ael , (�(I,IPS114;4/.Cxze4 <br /> `NOWNER(Pease Print) Contractor or Surveyor or Agent m � <br /> Ls:: [, LJ -20 a <br /> Address _ Address 00 <br /> City, State,Zi Code City, State,Zip Code <br /> 33 <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name / S y / NSU 7 0 <br /> Legal Description (as Indicated on tax statement) <br /> n L7 <br /> 0 <br /> Permit(s)Applied for: ^- <br /> Dwelling Addition Filling/Grading Camping Unit <br /> v <br /> Z o <br /> Accessory Building _ Sanitary Privy Subdivision ° } <br /> arage <br /> Structure Use: ���` a 11/a Cc oil .��+A� `- f), s/Y o <br /> (family home/cabin,garage,addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 9 <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 draintleld (DF). 11 3 <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 a <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and w <br /> dated by the owner. C 1 0 <br /> PLOT PLAN m <br /> h) <br /> 1 <br /> c C&w Dr n/ <br /> Vap k)ce' <br /> r <br /> Z <br /> ( <br /> g. aa'� mo' H `i $ = <br /> < w ,ZC 3 <br /> Z o o , <br /> 010 <br /> C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- o C <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this in or <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 m $ <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.1 agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. ' m 8 <br /> B � A <br /> SIGN HERE'4 H d <br /> (signature of owner or building cont r tor) (date) e s <br /> ZONING ADMINISTRATOR g <br /> TOWNSHIP PER ITS MAY BE REQUIRED 9985 <br /> 88888 c <br />