Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m 'U -4 <br /> 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 m <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 0. <br /> regulations of the State of Wisconsin. ° <br /> _SOMAS MILL�2 N <br /> C <br /> ?o <br /> OWNER Please Prim) Contractor or Surveyor or Agent o <br /> l l3 E- JEn�KS <br /> Address Address `) <br /> �I ?AOL MO • 5!�loc- <br /> City State,Zip 'rd City, State,Zip Code , <br /> lot2- '��l`�- �11�4 � <br /> Telephone Telephone Ja' <br /> 2HS0 LbNt TWE RD , <br /> Emergency/Fire No. and Road Name <br /> /yIJ <br /> Legal Description (as indicated on tax statement) <br /> Permit(s) Applied for: o °- <br /> '^ r <br /> Dwelling Addition Filling/Grading Camping Unit °^ <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision P <br /> Garage / j'l r <br /> Structure Use: ��}14 I Tf I F I lJi �� 1 eh r <br /> (family home/cabin, gara e, addition,et .) C1J <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). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfleld (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 � Z c <br /> measurement to the ordinary high water mark of lake,stream,or river. O o a <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and fA y <br /> dated by the owner. <br /> C , <br /> PLOT PLAN m <br /> L lJ <br /> Ei <br /> I <br /> N <br /> O (\ <br /> 7 <br /> v � <br /> N_ <br /> Zu^ <br /> 1 9 <br /> `r r <br /> o c m a F m <br /> v m <br /> Z n m C 3 t0 1 <br /> TNi 31 <br /> M <br /> a i n c i O <br /> 8i a= I c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 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- « m N O <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 $ A 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- N <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. m $ m <br /> m 3 A H <br /> �/ � « $ <br /> SIGN HERE - 644 H a i <br /> (signatuire of owner or building contractor) <br /> ZONING ADMINISTRATOR a $ <br /> TOWNSHIP PERMITS MAY BE REQUIREDa . ) 0 8 O m <br /> $ 88°88$ 80 <br />