Laserfiche WebLink
Burnett County 7.410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 <br /> APPLICATION FOR - LAND USE - PERMITS3. <br /> m p <br /> TO THE ZONING ADMINISTRATOR:,rne undersigned hereby makes application for a Permit for the work described and v w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ o <br /> regulations of the State of Wisconsin. m <br /> 2 (rte,_ �Put �rKc' LS �OhYI � C, n m f <br /> OWNER(Pleas Print) Contractor or Surveyor or Agent o <br /> Address/ Address <br /> / oa*�, 4.m�Q � S"S4za `�popa� rJ .i SS�rYO � I )' <br /> City, State,Zip Code City,State,Zi Codesu <br /> 2.0 T= v of <br /> Telephone Telephone I <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as Indicated on tax statement) <br /> � L7 <br /> Permit(s) Applied for: o <- <br /> Dwelling Addition Filling/Grading Camping Unit o <br /> 0 <br /> z o <br /> Accessory Building Sanitary Privy Subdivision m <br /> Garage <br /> Structure Use: t✓ N q // a 0�++�r �DI //� ��l ( /?�""'fj�...��/\�S, <br /> (family 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). <br /> 2. Show the location of the well (W),septic tank(ST),and drainfield (DF). 0 3 <br /> 3. Showdimensions Infeet afthefollowing:(a)buildingto all lot lines,(b)buildingto center line of road,(c)building on `v <br /> measurement to the ordinary high water mark of lake,stream,or river. . o S <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m y <br /> dated by the owner. <br /> C t <br /> PLOT PLAN z <br /> I <br /> U1 <br /> e Akamq broa.vl A - <br /> 0 <br /> o <br /> m <br /> Z <br /> 1 <br /> � < ��/ �a � Perm 5, <br /> 3ro <br /> i N i (,7 Cai C <br /> 8 c : <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- o : mrr <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- yy!! m : C <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 91 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 ' n o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 8 <br /> T 3 A r <br /> Z- <br /> SIGN HERE N a f <br /> ( Ipnature of.�rn or ding acto W NEe : s : <br /> ZONING ADMINISTRATOR g <br /> TO NSHIP PERMITS MAY BE REQUIRED Z <br /> Iljl!�'.i �� 888888u <br />