Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m M a o <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 m 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. y m <br /> w m <br /> a <br /> OWNER FI se Pr' ) Contractor or Surveyor or Agent <br /> J`J /. Rt <br /> m q' <br /> Address Address <br /> City, State, Zipode —pmf//��// // City, State,Zip Code <br /> M � I <br /> Telephone Telephone <br /> I <br /> Emergency/Fire No. and Road Name �\ <br /> Legal Description (as indicated on tax statement) <br /> C <br /> Permit(s)Applied for: 3 °- <br /> Dwelling Addition Filling/Grading Camping Unit <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision P <br /> Garage fF/, <br /> Structure Use: U� Jj <br /> 0 <br /> (family home/cabin, rage, addition, .) Milt <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). O <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (OF). 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. on 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 � y <br /> to lake, river or stream, if applicable. of <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. <br /> M W <br /> c <br /> PLOT G"? ,f .a�hv— i.(�. � � �i � ,� g ..J� <br /> �/I✓`r- C'� �1��d ��✓' t � i 1 '° _ J,J <br /> 01 <br /> / O <br /> J <br /> \ m <br /> 2 <br /> {IDS <br /> � f <br /> o c m m o n V � <br /> y <br /> ma. � H o3ro' 3 <br /> Z o ' m `2 : <br /> 9 31 <br /> mac : m <br /> i G) 2 : [ O <br /> C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- : o m M <br /> 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 it w O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- M N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g 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 a <br /> access to the above described premises at any reasonable time for the purpose of inspection. w g a <br /> m A e <br /> SIGN HERE <br /> (signat f of owner r bui actor) date) <br /> ZONING ADMINISTRATOR JZ44 -t <br /> N' <br /> TOWN IP PERMITS MAY BE REQUIRED no 0 m <br /> 8 8�888ai <br />