Laserfiche WebLink
0-o u) <br /> t � <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI SM72 Office of Zoning Administrator U m a o <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 v <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 /> re(g�ulations of the State of /W''Sconsin. /� <br /> NO N.OL/ �U MG( IES�` Jo002—Wt �1 /7, aln//�T Y�I� a <br /> m O <br /> O;r R Pease Print) G� Co/ractor or Su�eyorLSAg� /J m ,J <br /> Address`/ Ad <br /> gon..re )i /G Mw. S� 337 �gwia&, z u %� SYs3� � Ur" <br /> City State,ZiCode City, State,Zip ode ( <br /> �9�2i/4.- �9v-Goa Gni - 3G�� o <br /> Telephone Z� Telephone <br /> . ,a.�d Raaf <br /> �Em gency Fir No. and Road 14 me <br /> �, A / ter, �>� #/ Sge- / Titi'd-R/SCJ <br /> Legal Description (as Indicated on tax statement) <br /> c� <br /> 0 <br /> Permit(s)Applied for: <br /> Dwelling Addition _ Filling/Grading Camping Unit <br /> v <br /> z o <br /> Accessory Building Sanitary Privy Subdivision P m � <br /> Garage <br /> Structure Use: 11 < !NWA - o <br /> (family home/cabi(garage, addition, etc.) <br /> 1A <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). S <br /> 2. Show the location of the well (W),septic tank (ST), and drainfleld (DF). �3 u <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to carrier line of road,(c)building z `v <br /> measurement to the ordinary high water mark of lake,stream,or river. o o <br /> 4. N 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 /> PLOTAAN <br /> 6oI \ >< l <br /> N <br /> �o _J x <br /> Nb _ w f:n <br /> z <br /> f <br /> o c n m o a Mo <br /> m <br /> M <br /> ,2m o5m' 7' <br /> N m <br /> o Z' J T� M <br /> 4* ! (Q COY/` �lGr6�i/�.C. # l,� : Y'" ' ct 3 O <br /> M <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- S. <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa- y!n! it MO <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 g 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. I agree to permit county officials charged with administering county ordinances or other authorized person to have O ly o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m g , <br /> 3 A , <br /> a <br /> SIGN HERE—/ ---- n <br /> (date) <br /> (signat a of owner or building contractor) c x <br /> ZONING ADMINISTRATOR m EjJ I'^ <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N N <br /> N N N O O <br /> g $ 8gg $8grml. <br />