Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; m o 0 <br /> 2.m <br /> ? <br /> APPLICATION FOR — LAND USE — PERMITS o TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the (11 c <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 <br /> r"tions of the State of Wisconsi H m <br /> w <br /> o <br /> F <br /> 7 R Please Print) L, C rector Sury o o Agent m m <br /> A dress Addr ) (/� <br /> City, tate,Zip Code City,State,Zip Code' <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name 1 <br /> Legal Description (as Indicated on tax statement) ° l <br /> Permit(s)Applied for: 0 C. <br /> r <br /> Dwelling Addition Filling/Grading Camping Unit g <br /> v <br /> z o <br /> Accessory Building Sanitary Privy Subdivision o <br /> Garage <br /> Structure Use: o <br /> (family home/cabin,garage,addition,etc.) <br /> 0 <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 drainfleld (DF). v u, <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building if Z `c <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 o <br /> dated by the owner. C i 0 <br /> PLOT PLAN m <br /> �1 <br /> o <br /> O y <br /> w <br /> .. I <br /> Z <br /> V" <br /> i; <br /> o c T m m o n -ran <br /> =a� $ $ $33 a <br /> �_ � Z0 o 3m <br /> O l�QQ.a O Q <br /> 2 J 21 y: m <br /> G C <br /> C <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 informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 25 ro a <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 1 am providing in this ap- 13 <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have ,„ g <br /> access to the above described premises at any reasonable time for the purpose of Inspection. i 8 <br /> m 30 : <br /> A V yA N <br /> 0 W ypp <br /> M c7 O : <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR ' <br /> N i <br /> TOWNSHIP PERMIT MAY BE REQUIRED In 9 a N o o m <br /> 88888888rma <br />