Laserfiche WebLink
Burnett County,7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d -.0 <br /> APPLICATION FOR - LAND USE - PERMITS 3' ' <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the N A <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 0. <br /> regulations of the State of Wisconsin. H m <br /> m <br /> 11�1'�C�nZ�wes�r1Pa �' �AP�C � l / 1 a f <br /> OWr•�R (Pie se Prim) Cor�ractor Surveyor Qr Agent <br /> t.R . Y !,,, F . �`o <br /> Add/[B�$s�y�-� ¢ <br /> L.CJ'(I !✓T�1'l �� -J��.� A 1 frlQ a <br /> City,State,Zip Code City,State,Zip Code <br /> Telephone Telephone — <br /> QJ <br /> Emergency/Fire No. and Road Name ; <br /> Legal Description (as Indicated on tax statement) <br /> n cf <br /> 0 <br /> Permit(s)Applied for: 0 �- <br /> Dwelling Addition Filling/Grading Camping Unit o <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision <br /> Garage <br /> Structure Use: o <br /> (family home/cabin, garage,addition, etc.) O <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). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfieid (DF). on 3 n <br /> 3. Show dimensions In feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building on ' `c <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 o <br /> dated by the owner. <br /> PLOT PLAN m <br /> 0 <br /> o <br /> o <br /> N <br /> Z <br /> I <br /> C <br /> O C M S- n 2 V 9 <br /> m =Q� aam atD a <br /> a <br /> o Q 3 <br /> oo . m ,2 ; 1 <br /> F o i T m f M <br /> M <br /> 8i <br /> M <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my forms m <br /> o 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- '� a O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this init. 1 8 m ut <br /> 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- - u <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have n N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. ^' 8 m <br /> ^ N <br /> a ap <br /> M N 8 i <br /> SIGN HERE H a <br /> (signature of owner or building contractor) (date) o s <br /> 1t�1 r1PvIgr1CJ S ' <br /> ZONING ADMINISTRATOR i IH <br /> TOWNSHIP PERMITS MAY BE REQUIRED N m <br /> $ 8888888 (0 <br />