Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d ; o ` o <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> ID ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> rre/e++ggulations of the State of Wisconsin, w m <br /> l °�G2C• /� AIT—" Ale aTifL&" j) /3U11- 0frle S a o <br /> OWNER(Please Print) orr��raaey <br /> or or Su or or A ertt <br /> 1 T /2 ✓. TZ / � R � G � I <br /> Address Address <br /> Dvi_Vr6.1- iw, H . �'S 1 1 <br /> City,State,Zip Code City,State,Zip Code <br /> 3. 1 & - f) a ® 7 �/S � � S `i _ -3 ? <br /> Telephone Telephone t <br /> 1 310 11 'TtDOR LAK< QRI V�' .04_W V12yr 4,V r <br /> Emergency/Fire No.and Road Name <br /> Legal Description (as Indicated on tax statement) <br /> o O ) <br /> Permit(s)Applied for: o` °- <br /> _ <br /> ur r <br /> Dwelling Addition Filling/Grading Camping Unit o g <br /> T <br /> z a <br /> Accessory Building Sanitary Privy Subdivision ° <br /> a <br /> Structure UsGarage <br /> (family home/cabin, garage,addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) Q <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings(NB) and Indicate North (N). 9 O <br /> 2. Show the location of the well (W),septic tank (ST),and drairdield (DF). 0 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 Q <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 w <br /> dated by the owner. <br /> C I <br /> PLOT PLAN M <br /> m <br /> 1 I - <br /> p �^ f <br /> a y oa 1 m <br /> / do <br /> q o <br /> J � <br /> 1N n <br /> J <br /> h� <br /> -3SD/ a Z <br /> P�,2�ri1T ios4l -Iqtod--� <br /> yrI�C/ 1W11�6 I� m o c ° m m n n m <br /> z ; o : m ,2 , °o <br /> 1 <br /> ° > _ 21 M <br /> rz : m <br /> S7c O <br /> 8 c : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knows- o 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- m O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor-mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I m <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 m, <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> r 3 <br /> SIGN HERE - _a 3 J1 « m <br /> ignatyp of owner or builds g contractor) (date) <br /> ZONING ADMINISTRATOR t71 <br /> TOWNSHIP PERMITS MAY BE REQUIRED yi $ o o m <br /> 88888888gmi <br />