Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator c o <br /> APPLICATION FOR — LAND USE — PERMITS 3o. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 <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 a <br /> regulations of the State of Wisconsin. ° <br /> Mall-En I' <br /> a � <br /> >: <br /> OWNER ,Please5 Print) Contractor or Surveyor or Agent o <br /> 0?101� <br /> Address Address 7� <br /> Sllcrsn rr �l�'g S�Rd► ( 1 - <br /> City,State,Z' Code City, State,Zip Code ) <br /> 71 '7 - Slag 5 <br /> Telephone Telephone <br /> is ll S ( 4 <br /> Emergency/Fire No. and R ad Name <br /> Legal Description (as Indicated on tax statement) q <br /> Permit(s) Applied for: o <br /> 0 <br /> y r <br /> Dwelling Addition Filling/Grading Camping Unit o ° <br /> v <br /> z o <br /> Accessory Building Sanitary Privy Subdivision P <br /> Garage .� <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). M n <br /> 2. Show the location of the well (yi),septic tank (ST),and drainfield (DF). 0 3 <br /> 3. Show dimensions In f eat of the following:(a)building to all lot lines,(b)building to center line of road,(c)building Z Q <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 m n' <br /> dated by the owner. C <br /> CEL <br /> PLOT PLAN 0 t <br /> M <br /> Q rn <br /> n_ <br /> O <br /> J <br /> o I.n <br /> J Ilf✓� <br /> J <br /> m <br /> O � <br /> r � W <br /> Z <br /> m o c :P a m a F T <br /> m a N a g n <br /> N O <br /> O N _• : : N 1 <br /> O . <br /> F J Tom ; In <br /> = <br /> In <br /> C <br /> I 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 informa. <br /> m <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 a permit. 1 8 0 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 8 m� <br /> m 3 e <br /> SIGN HERE J4.44 <br /> (signature of owner uilding contractor) (date) : s <br /> ZONING ADMINISTRATOR UP <br /> g <br /> N. <br /> TOWNSHIP PERMITS MAY BE REQUIRED ��ry a o o�S m <br /> 9998888ai <br />