Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rn MZ <br /> 0 m f o <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and -2 H <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 /> regulations of the State of Wis o si /tP r) w o 0 ) <br /> _ e tome � P S� a o <br /> OWN R Please Print Contractor or Surveyor or Agent o <br /> o? r�IIP I .ao� <br /> Address Address <br /> S''xie zL L4f ! ' ( <br /> City, State Codq,2 L , / City, State,Zip Code <br /> Tel hone j�.//J V 5! <br /> X2S�.S V r� L �/70� [ Telephone <br /> Emergency/Fire No. a d Road N me <br /> ive �y sw�y , le-c,33 1738w — pig c <br /> Legal Description (as Indicated on tax statement) o <br /> Permit(s) Applied for <br /> o < <br /> _ <br /> m � <br /> Dwelling Addition Filling/Grading Camping Unit o ° <br /> v <br /> Accessory Building Sanitary Privy Subdivision ° <br /> Garage f p t <br /> Structure Use: �fvt , V�l/1 / O 4y I r <br /> —j_ fai;r(ily 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). n <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (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 3 c <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 A H <br /> dated by the owner, m o <br /> 1 ' <br /> PLOT PLAN M <br /> m = r <br /> ,t <br /> a <br /> _ <br /> N <br /> vm <br /> LS <br /> ���T " c C <br /> 42 m 1 <br /> f = : r a <br /> ) � 10 <br /> mc ! C <br /> A ' <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 8 <br /> o am <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- y, m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 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 v, <br /> access to the above described premises at any reasonable time for the purpose of inspection. w g m <br /> m 3 A N <br /> m � <br /> 8 a <br /> N 'N : <br /> SIGN HERE �""'� — L/ 9� w a <br /> (si u of owne or uilding contractor) (date) <br /> ZONING ADMINISTRATOR "1' 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N o o NS m <br /> 88888888y <br />