Laserfiche WebLink
Cr ., � 'C <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U -. 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> 0 <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 requirern of the m 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 /> RIZUCIE- 5WNn73OAj 7?0 )) WtL5OvJ c 0 <br /> f <br /> OWNER(Please Print) Contractor or Surveyor or A ent o �, <br /> 4/020 ABF3oTT LhJ i�iox3C/3 SlJWKAI9 10 <br /> Adtlress �I1 Address <br /> MI N fj E e rvllfa It t tv 55,3 V S V13 0 <br /> City,State,Zip Code City, State,Zip Code <br /> Telephone Telephone <br /> (via — 93s-5o -7 `?/ sJas/�- ae-7,9 <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as Indicated on tax statement) o ) <br /> 0 <br /> Permit(s)Applied for: 0 ° <br /> Dwelling Addition Filling/Grading Camping Unit o g <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision o <br /> Garage <br /> Structure Use: -w tp hG r� 1.7 L,-b r{oo�+�- <br /> 0 <br /> (family home/cabin,garage, addition, etc.) <br /> 1A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) M <br /> a <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 drainfield (DF). 3 <br /> 3. Show dimensions in feet of thefollowing:(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. o a <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and m H <br /> dated by the owner. <br /> C <br /> PLOT PLAN <br /> 5< w <br /> N <br /> m <br /> n_ <br /> 0 <br /> 0 <br /> o <br /> m <br /> m <br /> n <br /> Z <br /> i <br /> C� <br /> G <br /> m o c m d n g m <br /> �. Dai mam o, SM <br /> < < : .z 5C000 �' 3 <br /> _ gq o 0 '2 : 1 <br /> Y TN: M <br /> m <br /> N c> C, g i O <br /> m c C <br /> g mi M <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. o m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- w m u O <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this infor- b"m N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 m 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. N <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have 000 <br /> access to the above described premises at any reasonable time for the purpose of inspection. : m 8 m . <br /> m V A n <br /> m : m <br /> SIGN HERE r42t6 <br /> � <br /> (liigre of owner or tiding contractor) (dale) (} j. 8 <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED H.0 "0100 NN 75 m <br /> 88888 $ $ 870 <br />