Laserfiche WebLink
D <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d o <br /> TO 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 0 m <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. <br /> R C{ ark{ T, nDi p— a <br /> f <br /> OW ER fFlease Print) T Contractor or Surveyor or Agent o <br /> Addre s � <br /> �r � I� Address <br /> KQJ1 <br /> City, State,Zip Code City, State,Zip Code I U� <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as Indicated on tax statement) o <br /> � � 1 <br /> Pe(mit(s)Applied for: o °< <br /> Dwelling Addition Filling/Grading Camping Unit o ° <br /> Z o d <br /> Accessory Building Sanitary Privy Subdivision ° <br /> Garage r � <br /> Structure Use: �qn —r Il�itJl ol-) l U o <br /> (family home/cabin, galrage,addition, c.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 9 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). 0 <br /> 2. Show the location of the well (yi),septic tank (ST),and drainfieid (DF). 3 <br /> 3. Show dimensions infeetofthefollowing:(a)building to all lot lines,(b)buildingto center line of road,(c)building on Z 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 n = <br /> dated by the owner. <br /> M y <br /> PLOT PLAN w <br /> M <br /> P>&n <br /> u� <br /> n <br /> 0 <br /> l� <br /> o � Ire <br /> 0 IT <br /> o � <br /> N <br /> I r h <br /> 0 o c m d o a F T <br /> a Dn d aN 31 <br /> 0 m 0 <br /> Fes : T N m <br /> = m <br /> N <br /> ii; C <br /> i m c E ' C <br /> g : m S <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 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 informa- fn m w O <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 8 it <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. g m 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 ut <br /> access to the above described premises at any reasonable time for the purpose of inspection. m g <br /> T 3 n <br /> � i m ay w f <br /> M N 8 <br /> SIGN HERE <br /> (signature of er or building contractor) (date) o x <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o 8 m <br /> 888w <br />