Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator u7 c o <br /> 3. 3 1E <br /> APPLICATION FOR — LAND USE — PERMITS d <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 <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 .� <br /> reg ti s of the State of Wisconsin. H d <br /> OWNER (Please Print) t Contractor or Surveyor or Ager o <br /> 75H4 �t/rrc Lµr.�c 2y5 �5 CL dM � yk< ,- w <br /> Addr-� Address <br /> Frc>G�V Ili ��H z Sire ti ivy r y 9r7z <br /> City, State,Zio Code City,State,Zip Cod <br /> /-6/2- �D- ���c� -- 7 /S - <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name <br /> Lpt ? 51111,,•- /I,cr9< S1 +1,4s 1.v --46 -4o-i7 <br /> Legal Description (as Indicated on tax statement) o <br /> 0 0 <br /> Permit(s)Applied for: <br /> Dwelling Addition Filling/Grading Camping Unit o g <br /> Z 'o <br /> Accessory Building _X1_ Sanitary Privy Subdivision <br /> Garage <br /> Structure Use: (To yy 4 vl , r <br /> 0 <br /> (amity home/cabin, ars 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 a <br /> 2. Show the location of the well (yi),septic tank (ST), and drainfleld (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 � Z _` v <br /> measurement to the ordinary high water mark of lake,stream, or river. o a <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and y <br /> dated by the owner. M ) <br /> C <br /> PLOT PLAN � "7 X � � G A✓ia � /Tem � / /Q�� /) g) <br /> StruC re heel eLwc( S r6ac�<f i <br /> 0 <br /> ^v N <br /> o <br /> 10T s <br /> o <br /> w <br /> I Z <br /> i; <br /> o c � m m n a F T <br /> < ` 2 m o m 3 <br /> Z o <br /> o <br /> F T to M <br /> » . m <br /> c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- rf g4 <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs- H m O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- `�' m u, <br /> malion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 9 . 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- �„ <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have C) m o <br /> access to the above described premises at any reasonable time for the purpose of inspection. mm 120 <br /> m �0 yp m <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) o <br /> ZONING ADMINISTRATOR <br /> N <br /> TOWNSHIP PERMITS MAY BE REQUIRED $ c o 8 m <br /> 8888 $ 888ro <br />