Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3, <br /> d a <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and -2 w <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 a <br /> regulations of the State of Wisconsin. QQ d <br /> � r�r s �0.tten �IIDS �L�tPci g y o <br /> OWNER Please Print Contracto or Sury r or A enI o ' <br /> �t�q Sn !r loo ��ti � d <br /> Addres rr Address i <br /> �ouwt LYct-tlouw -s-,4 <br /> _, lit �`4 i-zp 1 <br /> City, State, Zip de City,State,Zip Cod <br /> �l<.(a - `7`io=Z (� <br /> Telephone Telephone ...v <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as Indicated on tax statement) {(� <br /> Permit(s)Applied for: o 'C. <br /> 'r' r <br /> Dwelling Addition Filling/Grading Camping Unit <br /> v <br /> Z 'o <br /> Accessory Building Sanitary Privy Subdivision ° <br /> Garage <br /> Structure Use: °?yX�q <br /> (family home/cabin, garage,addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 2 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). 0 <br /> 2. Show the location of the well (W),septic tank (ST), and dralnfleld (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 11 Z <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 y <br /> dated by the owner. <br /> C <br /> PLOT PLAN — to <br /> M � s <br /> 1 <br /> i O <br /> Ch <br /> 0 <br /> J 0 <br /> 2 r m <br /> 1 YL) <br /> a ty��r i <br /> z <br /> A o c m m n a t m <br /> P Y J t T !n i i M <br /> .. �, G) 'C p <br /> m C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- g m m <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 /> tion contained in this application(including any accompanying schedule)and I further declare that 1 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 g m g <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 n N o <br /> access to the above described premises a any reasonable time for the purpose of inspection. m 80 <br /> A w <br /> ?� 5S <br /> / a0 € <br /> SIGN HERE Lei � '�^ a <br /> isi at a of owner o ing contractor) _ da c x s <br /> ZONING ADMINISTRATOR r5 g '. <br /> TOWNSHIP PERMITS MAY BE REQUIRED � <br /> I <br /> iXoo } m <br /> ni <br /> OU291991 8888888 <br />