Laserfiche WebLink
Bumett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator c o o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m o <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 (D c <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. n <br /> w m <br /> OWNER (Please Print) Contractor or Surveyor or Agent o <br /> �q� sl CSG- R /1 <br /> ddress Address <br /> DR�y S�lo2� , ulr 5 y8 { l <br /> city, State,Zip Codef <br /> City,state,zip code <br /> 7 130a .S . a St. <br /> Telephonq Crosqc ' I1 TelephoneIr <br /> I , <br /> Emergency/Fire No. and Flood Name <br /> �29aV <br /> Legal Description (as Indicated on tax statement) R <br /> Permit(s)Applied for: <br /> o <br /> Dwelling Addition Filling/Grading Camping Unit 0 <br /> Z <br /> Accessory Building Sanitary Privy Subdivision P <br /> Garage I � / I' <br /> Structure Use: IArhiLV ! ?iyl[� - Sr l` no', Sj o <br /> (family home/cabin, garage, addition,etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 10 <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 drainfleld (DF). 0 3 <br /> 3. Show dimensions Infest of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building z o <br /> measurement to the ordinary high water mark of lake,stream,or river. � o o <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and O N <br /> dated by the owner. M <br /> C <br /> PLOT PLAN <br /> 3 <br /> C9 <br /> m <br /> 0 <br /> N <br /> 0 <br /> m <br /> o � <br /> ��j w <br /> Z <br /> i; <br /> w D C N z m F <br /> $ m < 5 <br /> m � <br /> P 03S <br /> � N . D <br /> O `eE <br /> g <br /> IF <br /> C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- g 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- w m O <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this infor. <br /> motion 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 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. T 3 8 <br /> r : <br /> w <br /> SIGN HERE <br /> a : <br /> (signs f ow er ui)di co rector) <br /> ZONING ADMINISTRATOR 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED i� (� APR 2 3 �, o o5 In <br /> II,I 88888888m <br />