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N 7 <br /> 410 Co. Rd. K, No. 702, Siren, WI 54872 Office of Zoning Administrator m oti ZP <br /> APPLICATION FOR - LAND USE - PERMITS 3. ' <br /> 0 <br /> ,ING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 2 c p <br /> Bv(shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 3 0 <br /> ,d County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. o <br /> m o <br /> OWNER ,/ TE <br /> Z � /� /yh� LEPHONE <br /> ADDRESS 61,r <br /> �SO Ldd ?/ 1 <br /> EMERGENCY/FIRE NUMBER Y 7 ROAD NAME .0 Oc)d <br /> LEGAL DESCRIPTION (see tax receipt/) CZ / v✓ 7-6 PC L Z� <br /> CONTRACTOR UJB ei' -f <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o °< <br /> I 1 ' <br /> m � <br /> STRUCTURE/ADDITION USE: 4ea <br /> p fed �If <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z 'o <br /> O p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> } <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 drainfield (DF). <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinary high water mark of lake,stream, or river. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and - O <br /> dated by the owner. 0 ° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o N <br /> �I Z Q <br /> O a <br /> PLOT PLAN ,i; m _. <br /> C <br /> Q-) <br /> c <br /> ItI e <br /> 3a ' IF N <br /> h18 r,yOJ <br /> rr+G;n 'Poecl G <br /> C 1 G <br /> D <br /> 1 0 <br /> o <br /> N <br /> /4 <br /> j I <br /> G <br /> NVNr DDOZ <br /> l m Kr. D. 0 of n <br /> CONDITIONS OF PERMIT: <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p F Z T vi , <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y^, rl <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Qf o o <br /> ? ' S C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- ,o'er : H <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs r <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- C <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 o o <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 O <br /> access to the above described premises at any reasonable time for the purpose of inspection. T 93 o m <br /> G'L'�"' -Gy[ M N O <br /> SIGN HERE H <br /> (sig ur of own uildinq contractor) date) � � [ <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N W N N V V l <br /> O m N p l 6 N U l <br /> ! 000000 , 01 <br />