Laserfiche WebLink
Burnett County,7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratorw 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 �^ m <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 <br /> 0 <br /> regulations of the S of Wisccoonsin. n h <br /> OW (Please rint Contractor or Surveyor or Agent m m <br /> 'I; . <br /> Ad ress/1 Address <br /> �l ,f(�CiP (A tF - (LI <br /> City,State,Zip Code City,State,Zip Code <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as Indicated on tax statement) <br /> 0 <br /> Permit(s)Applied for: <br /> S o <br /> Dwelling Addition Filling/Grading Camping Unit v <br /> Z a <br /> Accessory Building anitary Privy Subdivision i <br /> Garage <br /> Ad <br /> �^ <br /> Structure Use: <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 drairdleld (DF). 3 m <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building Z `o <br /> measurement to the ordinary high water mark of lake,stream,or river. ° a <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 = <br /> I <br /> PLOT PLAN M <br /> C� <br /> Po-E <br /> 0 <br /> _ <br /> o <br /> N <br /> r <br /> Z <br /> 1 <br /> G <br /> M o c m m o a F 9 <br /> _ � m <br /> m. D � m =aN ?m a <br /> @'N A Z I <br /> P2 F ' 4i N; M <br /> 4t2 O <br /> C <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- N w w O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. $ro <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $ 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.1 agree to permit county officials charged with administering county ordinances or other authorized person to hav nP o . <br /> access to the above described premises at any reasonable time for the purpose of inspection. g 8 2 <br /> m <br /> a <br /> a ; <br /> SIGN HERE <br /> (signature of o er building contractoIr) (date) o <br /> ZONING ADMINISTRATOR �m �A>J IA>i"Al <br /> N N M <br /> TOWNSHIP PERMITS MAY BE REOUIRED 8 8 S <br />