Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o` o <br /> APPLICATION FOR - LAND USE - PERMITS 3' ' <br /> 0 <br /> TO THE 70NING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnen County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3. <br /> regulations ofthqe State of Wisconsin. �t w d <br /> M�L�fiN CA INN A5 k- a 0 Z $ <br /> PI Pr' ) Contractor or Surveyor or Agent m m <br /> RD <br /> m <br /> Lo <br /> dr ' - S Address v <br /> City, State,Zip Cod# City,State,Zip Code <br /> Telephone Telephone W <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as Indicated on tax statement) <br /> Permits) Applied for: 0 ;- <br /> M <br /> w o / <br /> Dwelling Addition Filling/Grading Camping Unit ° r <br /> Zo <br /> Accessory Building Sanitary Privy Subdivision °_ <br /> Garage <br /> Structure Use: .) <br /> 5 <br /> (family home/cabin,garage,addition, et 9J <br /> G I <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) M <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). v <br /> 2. Show the location of the well (W),septic tank (ST), and dralnfield (DF). 0 v <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 ) <br /> measurement to the ordinary high water mark of lake,stream,or river. c <br /> 4. if separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. <br /> C <br /> PLOT PLAN fA < <br /> I <br /> o IN <br /> m <br /> tJ <br /> o <br /> Z <br /> N <br /> a <br /> I� <br /> T o c m r n n V m <br /> ' D R.� � Cin o S' M <br /> �. x '� o <br /> O on <br /> J Z= (n M <br /> <- 2 m <br /> D O <br /> P c i C <br /> : m: [ a <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 informs- y»!m g O <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this infor- E S m i7 <br /> motion 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 a - <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have 8 <br /> access to the above described premises at any reasonable time for the purpose of inspection. $,� <br /> 2 � ^ " <br /> SIGN HERE . « ' ' <br /> (signature of owner or buiillldd-i(n�g�contractor) I (date) <br /> ZONING ADMINISTRATOR — <br /> N NNN T <br /> TOWNSHIP PERMITS MAY BE REQUIRED )"n S o o S in <br /> 88888888ro <br />