Laserfiche WebLink
A I ij l <br /> Burnett Counly 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; 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 ? N <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 n <br /> regulations of the State ofWisconsin. m <br /> ied. C-)RA_, �W-K- MAg-S <br /> OWNER(Pleas Prim) Cont 2m <br /> or or or o em v <br /> r <br /> Addre� �r� , �� �� Addre ZiCoddodbNgN <br /> City, Sta�a,Zip Code City, Sta Zip G� <br /> f <br /> Telephone Telephone <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as Indicated on tax statement) <br /> n O <br /> Permit(s) Applied for: o <br /> o �^ <br /> Dwelling Addition Filling/Grading Camping Unit 0 g <br /> v <br /> 0 o <br /> Accessory Building Sanitary Privy Subdivision ° <br /> Garage <br /> Structure Use: I r <br /> 0 <br /> (family home/cabin, garage, addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 9 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). 0 0 <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 0 o u, <br /> 3. Show dimensions infeet of thefollowing:(a)building to all lot lines,(b)building to center tine of road,(c)buildingZ cc <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 andm S <br /> dated by the owner. <br /> C �C7t <br /> PLOT PLAN M G) <br /> t <br /> P <br /> n_ <br /> 0 <br /> N I (� <br /> > I \ J <br /> O y <br /> N_ <br /> n <br /> 2 <br /> z <br /> ) <br /> m m C m m A Q O <br /> F m <br /> 9 < < Z H O J 10 3 <br /> N <br /> O F, O A,2 1 <br /> f > T N <br /> � ^ m <br /> cy � O <br /> 'm c C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knows- S 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 O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- �"�'m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I i $ m g <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 n N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> n <br /> m � v A H <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) vo x <br /> ZONING ADMINISTRATOR 6 ( $ <br /> IgN�lAHMMT <br /> TOWNSHIP PERMITS MAY BE REQUIRED u JnJ n 8 Jn o o f5 m <br /> 88888888rmn <br />