Laserfiche WebLink
b7. r C , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d a o c <br /> APPLICATION FOR — LAND USE — PERMITS0 s <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shownf herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and rs <br /> regulations of the State sconsin. w m <br /> P m Ack<C(;t 15<� <br /> OWNER (Pleas Pri O Co actor or rveyor or <br /> .n . Y m <br /> Ad res A dr ss <br /> mmtr)rxE tin f (YlN LB,42 h �l [Ar <br /> City, State, Zip Cod City, State,ZipCode ' <br /> Telephone Telephone <br /> Emergency/Fire No.and Road Name <br /> Legal Description (as Indicated on tax statement) <br /> � O <br /> Permits) Applied for: 0 °. <br /> 0 <br /> Dwelling Addition Filling/Grading Camping Unit _ °^ <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision c m <br /> Garage <br /> Structure Use: <br /> 0 <br /> (family home/cabin, garage,addition,etc.) <br /> 1A <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). <br /> 2. Show the location of the well (W),septic tank(ST),and drainfleld (DF). 3 y <br /> 3. Show dimensions In feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building If - `v <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 1 w <br /> dated by the owner. C <br /> PLOT PLAN M <br /> ccI <br /> �� 13 P ^ 1-7c) <br /> i; <br /> 0 JlJ <br /> O I „ <br /> J IL` <br /> m <br /> O � <br /> h <br /> ^ I� <br /> J <br /> n O C � m m o a r9jt <br /> mo , m � <br /> N <br /> c , m <br /> G) � O <br /> 8 m <br /> a <br /> i <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- - <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- !� m�. p <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I 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. 1 $ e $ <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 <br /> 0 <br /> o <br /> access to the above described premises at any reasonable time for the purpose of inspection. u $ <br /> [ � Ax : <br /> SIGN HERE '' a <br /> (signature of owner or building contractor) (date) o s, <br /> ZONING ADMINISTRATOR ` )I rY\ E I An ILLL-) 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o m <br /> 88888888ro <br />