Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; M 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 2 m O <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the ro m <br /> Burnett Courtly Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 0 <br /> L <br /> regulations of the State of Wisconsin. H m 1 <br /> w m O <br /> n F <br /> Oy e e @nn o Contractor or Surveyor or Agent <br /> Ad es Address (T) <br /> city c p c & � City,State,Zip Code <br /> Telepho � Telephone 1 — <br /> Emergency/Fire No. and Road Name �� // <br /> Legal Description (as Indicated on tax statement) f��//-�/�,/A— o ) <br /> � O <br /> Permit(s) Applied for: 0 'C. <br /> Dwelling Addition Filling/Grading Camping Unit 6 <br /> v <br /> Z o ' <br /> Accessory Building Sanitary Privy Subdivision ° _ <br /> Garage <br /> Structure Use: <� - <br /> •J (family home/cabin, garage,addition, etc.) 14 <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 drainf laid (DF). in 3 m <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 Cr <br /> measurement to the ordinary high water mark of lake,stream,or river. o 9 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and n N <br /> dated by the owner. M <br /> P , <br /> M <br /> PLOT PLAN Z <br /> t 'Yj <br /> vl� m <br /> o <br /> a <br /> Jm.. D Oc :2 m m o 6 y <br /> ro rn <br /> DG� m6H .za' = � <br /> 0 £ 0 T� 1 <br /> a <br /> I o <br /> C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- vv <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- (1 ' 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 <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- W <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises t any reasonable time for the purpose of inspection. m 3 $ <br /> ro v wI <br /> SIGN HER o�" <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> M <br /> TOWNSHIP PERMITS MAY BE REQUIRED 8 r o o 8 m <br /> N <br /> 88888888ai <br />