Laserfiche WebLink
County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratord o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 0 <br /> u THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the ro <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. N d <br /> �EIF <br /> 0 <br /> — f <br /> 0 R Please Prim) Contractor or Surveyor or Agent m <br /> m <br /> Addr ss rb Address <br /> City,State, Zip Code City, State,Zip Code <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name C11 <br /> Legal Description (as Indicated on tax statement) ly <br /> n 0 <br /> Permit(s) Applied for: :- <br /> '^ r <br /> Dwelling Addition Filling/Grading Camping Unit g <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Su ivision p <br /> Garage <br /> Structure Use: „ Y ) <br /> (famAy home abin,garage, addition, etc.) � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Ae al or top view) <br /> M F <br /> P <br /> 1. Show the location and size of all existing bui Ings (EB) and all new buildings (NB) and Indicate North (N). o <br /> 2. Show the location of the well (W),septic tank T), 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 0 z v <br /> measurement to the ordinary high water mark of lake,stream,or river. c o <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. C i <br /> (A <br /> PLOT PLAN f>f <br /> I <br /> Q C <br /> ��CNEo I <br /> N <br /> ro <br /> n_ <br /> 0 <br /> o V I` <br /> o � <br /> ')" z <br /> z <br /> f <br /> 0 c T m m o a m <br /> ro <br /> on <br /> S<2. <br /> aAn <br /> <° < X900. 8 ; <br /> Z f 0 0 ,2 M <br /> N m <br /> C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know)- .c <br /> 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- _ 00 M O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- `�ro N <br /> mation I am providing will be relied upon by the County of Burnell Wisconsin in determining whether to issue a permit. 1 g 0 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- N <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have i <br /> n 0 <br /> access to the above described premises at any reasonable time for the purpose of inspection. i w 8 0 <br /> m 3 <br /> ro v A a <br /> ro m £ <br /> SIGN HERE ; <br /> signature of owner Idi contr s <br /> ZONING ADMINISTRATOR <br /> TOWN IP PERMITS MAY BE REQUIRED JUL 41992 C N EVE O�'"s m <br /> N , <br /> 89 888 (Mn <br />