Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d ; o I o <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> v <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 3 OC <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ <br /> regula' s of the State of Wisconsin. . y m <br /> }�1� s(f c m <br /> 1 I u..�. 1 fl C 1�� Ki'iGFC n Q <br /> OWNER (Please P t) Contractor of Su ayor or Agent o <br /> Address �I yt t ( Add as ` `, � I <br /> 1) lleg CLN l.til / (W. `fGP ZJ`PCO l4(N ISNM I t��r J T �� <br /> City,State,Zip ode City, State,Zip C de <br /> fir > 7 `(�S <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name <br /> Sc NOe )JQv15 P- <br /> 12 � <br /> Legal Description (as Indicated on tax statement) S a3/Ty 0/P I (, lA) PC L- G o V Lo t <br /> Permit(s) Applied for: hCLR11o,1(e. i3.oaloe �L. oTIZ -7(�0) o o ` <br /> Dwelling Addition Filling/Grading Camping Unit o 0 <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision m <br /> Garage <br /> Structure Use: `IX Z 8 �20"`4 e r <br /> (family ho a/cabin, garage,addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) C <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). a n <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). 3 <br /> 3. Show dimensions in feet of thefollowing:(a)building to all lot lines,(b)buildingtocenter line ofroad,(c)building i Z a <br /> measurement to the ordinary high water mark of lake,stream, or river. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m <br /> dated by the owner. 0 <br /> C <br /> PLOT PLAN <br /> m <br /> �U <br /> oa , �� u <br /> 'p IYA115 <br /> E B Io <br /> ya' as x 38 <br /> s <br /> v HT <br /> o ° Q > > n a m <br /> m m <br /> o <br /> mom : : s <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- M <br /> �, 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" H m 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. I gag <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.1 agree to permit county officials charged with administering county ordinances or other authorized person to have u, <br /> access to the above d?scribed premisespt any reasonable time for the purpose of inspection. m g o <br /> r 3 <br /> SIGN HERE <br /> ignature ol owner or building co r) (d el s <br /> o : <br /> ZONING ADMINISTRATOR r g <br /> N_ <br /> TOWNSHIP PERMIT MAY BE REQUIRED S I' <br /> 8 $ 8 $ $ 888tto <br />