Laserfiche WebLink
01A u)" <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d o� o <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 m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. N m <br /> h4 �'�, Ato --L'� 7 f <br /> OWjJER (Pleas <br /> F�q e Pr' ) . Kit �- ` <br /> Contra or or Su eyor or Ag nt m° <br /> �g ' n . >�� <br /> Addre Address ' <br /> City, State,Zip Code City, State,Zip Code <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name I� <br /> Legal Description (as indicated on tax statement) <br /> 0 o <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 Subdivision ° } <br /> Garage <br /> Structure Use: 5 <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). o <br /> 2. Show the location of the well (W),septic tank (ST), and drainfleld (DF). '111 -63 w <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building III - o <br /> measurement to the ordinary high water mark of lake,stream,or river. c n <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 /> PLOT PLAN <br /> Q <br /> � ctv �� t <br /> � 3 <br /> � 0U N <br /> o <br /> I� <br /> N I11r`�rJ- <br /> 2 <br /> o .0 m -ran <br /> 2- 37 <br /> N000� 03 <br /> N . <br /> Z <br /> P n <br /> � ` Og L <br /> C <br /> g m m 3 <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- S : n <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <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 apermit. I $ m $ <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- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O o <br /> ection. <br /> access to the above ibed premises at any reasonable time for the purpose of insp <br /> m 33 n <br /> N N <br /> SIGN HERE <br /> (signat-ure <br /> of Crwner or building contractor) (date) V! ? o x <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED u N u o o $ r <br /> 8 $ 88 $ 8$ $ 1 <br />