Laserfiche WebLink
� r 7 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d -1 _0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3_ <br /> d o <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 '^ <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 0. <br /> regulations of the State of Wisconsin. �1n 'J y ° <br /> � l - (�1l1meP, I I ) I ISP �02 a <br /> OW1 R (Please Print) Contractor or Surveyor or Agent v �, <br /> Adtlress Addresl� e,-f WcQ � ��� <br /> City, State, Zip Code City,State, Ip Code <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as Indicated on tax statement) o <br /> 0 <br /> Permit(s) Applied for: o �- <br /> r <br /> Dwelling Addition Filling/Grading Camping Unit o °^ <br /> T <br /> Z o J <br /> Accessory Building Sanitary Privy Subdivision ° <br /> Garage <br /> Structure Use: _ <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 (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 (DF). 3 <br /> 3. Show dimenslonsinfeetofthefollowing:(a)building to all lot lines,(b)bulldingtocenter line ofroad,(c)building Z <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 m y <br /> dated by the owner. o <br /> C 1 <br /> PLOT PLAN m <br /> A"d Csr <br /> o <br /> 7 <br /> o <br /> N <br /> Z <br /> y <br /> m 0 C 0 0 0. <br /> LD M <br /> 0 M <br /> m o m r' m <br /> F0 = N1 flit <br /> N ' Ooi O <br /> 8 : n � c <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 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- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- m v, <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 8 a 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 ut <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 3 8 <br /> SIGN HERE <br /> (signature of[owner or building contractor) (date) o ! x <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REOUIREDN N N o o 8 m <br /> 888888 $ $ rmn <br />