Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d 7, o a <br /> APPLICATION FOR - LAND USE - PERMITS 3_ <br /> d O <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <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 Ordinan,e, Sanitation Code,and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. /p H d <br /> Cp • 1 n m F <br /> oh � o <br /> OWN (Please Print Contractor or Surveyor or Agent o <br /> m <br /> Addre <br /> 1%fAddress <br /> t <br /> . AL/ „. s t13 / <br /> City,St e, Code �— City, State,Zip Code <br /> r. <br /> Telephone Telephone <br /> -- —71 J- — 6 3y- - 1011 <br /> Emergency/Fire No. and Road Name C- / / (— <br /> Legal Description (as Indicated on tax state'me t) <br /> n 0 Y11 <br /> Permit(s)Applied for: o o- <br /> o <br /> Dwelling -I\- - Addition Filling/Grading Camping Unit o 2 <br /> = vo <br /> Accessory Building Sanitary Privy Subdivision ° <br /> Garage a <br /> Structure Use: f4'V"l r'+ �yr"-` r <br /> o <br /> (family home/cabin,garage, addition,etc.) � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (E8) and all new buildings (NB) and Indicate North (N). 0 <br /> 2. Show the location of the well (W),septic tank (ST), and dralnfield (DF). 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 <br /> measurement to the ordinary high water mark of lake,stream,or river. o n <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m y <br /> dated by the owner. <br /> ' ,��,�i1,,n„�f/*�1� a�`.� • <br /> � <br /> 9 C <br /> PLOT PLAN i � � of <br /> 10i, & <br /> oI <br /> o <br /> K� <br /> yG 0ny <br /> r <br /> �e �Inyti UGI �Ak h//K �h^• y <br /> m < fro ii � m 3 <br /> POD i m ,z ' M <br /> F : m m <br /> m <br /> � S oma : O <br /> m � C <br /> g ' m M <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- j 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- w m N O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- �'m u, <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 8 m g <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 agreeermit county officials charged with administering county ordinances or other authorized person to have m, <br /> access to the ove desc ed pr ises any reasonable time for the purpose of inspection. m g m <br /> n <br /> m m pp N <br /> SIGN HERE <br /> (signature of owner or buildin co r to!-,-. <br /> ZONING ADMINISTRATOR <br /> in <br /> TOWNSHIP P RMITS MAY BE REQUIRED MAY ' Y 1%2u,u,0 <br /> O NN N N O <br /> p <br /> 088888 <br />