Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m ' o 0 <br /> (� APPLICATION FOR — LAND USE — PERMITS d 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 <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and n <br /> regulations of the State of Wisconsin. m <br /> Sr,OH T lleelli' a W <br /> OWNER (Please Prim) Contractor or Surveyor or Agent o <br /> _ �f�0 G/. C ollnn'J s L Ir Rel � J <br /> Address Address <br /> l f/ P�15f�� l✓i• Syd�QT 0 r <br /> City,State,Zi e 8�6�1 City,State,Zip code <br /> Telephone Telephone � <br /> 7y70 W C_ohhOrf Gh /� <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as Indicated on tax statement) NiStoe y 35-19$7s r / LCI ae of 3&75'O ° i1 <br /> Pr—6 'Yo• /b• 35. ar/Sad 5 w sw 6r acts vaga P73<( v a/7 Pa�p � o <br /> Permit(s)Applied for: <br /> N � <br /> Dwelling Addition Filling/Grading Camping Unit <br /> v <br /> Z a <br /> Accessory Building _. Sanitary Privy Subdivision P <br /> Garage /r <br /> Structure Use: �?Arij <br /> 0 <br /> (family home/cabin,garage,addition, etc.) <br /> G <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) M <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). O o <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). 03 m <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building It z `e <br /> measurement to the ordinary high water mark of lake,stream,or river. o ? y <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m S n i�pr�J'J <br /> dated by the owner. C <br /> I <br /> PLOT PLAN I M tJ <br /> AlQj <br /> � l <br /> N <br /> SR p o <br /> N'0 Vi6 <br /> I Rol - <br /> � 4ak� � <br /> F!-9 <br /> I ( I <br /> � 8 80 <br /> I <br /> I � <br /> o .A -P m m n F m <br /> . g a <br /> R. A <br /> m, a •� <br /> R.O. N z, _ 31 <br /> zo m,z : `° 1 <br /> y ,y o <br /> C, T N <br /> ownf � �, � g <br /> mom : c <br /> 8 ' A : M <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- S : m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- yy!! m w O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- go 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 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 p <br /> access to the above described premises at any reasonable time for the purpose of inspection. a N 8y : <br /> T 9 A 1 : <br /> N : <br /> SIGN HERE (signature of owner or building contractor) (date) c ? s <br /> ZONING ADMINISTRATOR 1-- l <br /> pq R l <br /> TOWNSHIP PERMITS MAY BE REQUIRED 91 . $P oo o m <br /> 8 918888m <br />