Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m 0 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 � w <br /> UZ <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 of isconsin. w m <br /> n O <br /> OWNER(Please Print) Contractor or Surveyor or Agent m m <br /> A�1d92 West r a1.v0 <br /> J 'f r UV N p ,M((v N ,sS 3 u y Address <br /> City,,Cate�p Code S� City, State,Zip Code <br /> Tele hon QQZ 1 �M Telephone ) l <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as Indicated on tax statement) <br /> 0 0 <br /> Permits) Applied for: 0 �- <br /> m r <br /> 0 <br /> Dwelling Addition Filling/Grading Camping Unit <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision o } <br /> Garage <br /> Structure Use: G <br /> (family home/cabin,garage,addition,etc.) <br /> 1A <br /> G <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). O <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 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 o <br /> dated by the owner. C i 0 <br /> PLOT PLAN M <br /> l n <br /> rJ-1 <br /> 0 <br /> II � <br /> o <br /> N <br /> Z <br /> A ocmm � af�n <br /> m = $ $ a = x <br /> a m< . C o 5 m K <br /> Io � Q <br /> o ; 1 <br /> 7: *3 : TCn M <br /> cC : m <br /> L^ G) C o <br /> e : <br /> Am : a <br /> 1 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 accuracyof all informs- f N a N G <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor -�r`�� $m 9 <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 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- Qu <br /> plication.I agree to permit county officia charged with administering county ordinances or other authorized person to hav [ o <br /> access to the above ascribed pr Ise at any reasonable time for the purpose of inspection. ' m $ m <br /> m f 3 A F E <br /> 7- /0 - 9 / � <br /> SIGN HERE H n f <br /> (signature of ow er or building contractor) (date) <br /> ZONING ADMINISTRATOR IM �` `fy'nJ' 8 ` <br /> N <br /> TOWNSHIP PERMITS MAY BE REQUIRED n o o m <br /> 88 $ 88888tmn <br />