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�. Office of Zoning Administrator ; M o <br /> Rd. K, No. 102, Siren, WI 54872 <br /> PLICATION FOR — LAND USE — PERMITS o <br /> ,JISTRATOR:The undersigned hereby makes application for a Permit for the work described and c <br /> sin. The undersigned agrees that all work shall be done in accordance with the requirements of the a <br /> i Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and - o <br /> ,State of Wisconsin. <br /> TELEPHONE a <br /> 1 <br /> j 17.71 0CealOGE C.0Uer- 15A4A rl Mf- 55IZ3 <br /> � ^ _ U <br /> AGENCY/FIRE NUMBER 289 7 Z ROAD.NAME 5WlE,:GER, l � <br /> 'AL DESCRIPTION (see tax receipt) <br /> NTRACTOR UN o >=4 LD C-0 <br /> / O <br /> DE OF PERMIT(S): DWELLING/BUILDING V GARAGE/ACCESSORY STRUCTUPE ADDITION <br /> m <br /> 0 <br /> CAMPING UNIT SUBDIVISION <br /> FILLING/GRADING ^. <br /> NITARY�_ PRIVY m <br /> 0 <br /> o – <br /> RUCTURE/ADDITION USE: e—'4X>751 C� <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o v° <br /> m <br /> I � <br /> IRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). o <br /> Show the location of the well (W),septic tank (ST), and drainfleld (DIF). I <br /> Show dimensions in feet of the following:(a)building to all lot lines,(b)bullding to center line of road,(c)building O <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> If separate plans are submitted by an architect,engineer,builder,contractor,etc„the plans must be signed and O 0 <br /> dated by the owner. o <br /> TOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. Z a <br /> )LOT PLAN <br /> P <_ <br /> 1 <br /> NAM LA k4G m s <br /> \.Aie-E SihMGr_ %'IA r? <br /> V1w.r� a <br /> 1'iA <br /> 1 n <br /> a o <br /> �n <br /> r <br /> 6 sites " <br /> P'IAPe-r_I"`( L INE 1 <br /> T <br /> f <br /> ^ Mr D D a -0 <br /> 'g 0.m m <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REOUtREMEN79 WITHIN 60 DAYS OF PERM ISSUANCE. <br /> y: XI <br /> 2, REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. i 6� : m <br /> O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o ff <br /> C <br /> �4, <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o.E � i3 g ' <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of athis ll informa- d m <br /> tion contained in this application <br /> at on(inied upon a y accomlcountynofnBurnettWisconsule)and linU n deterther rmining ng whetherclare that I gto issuenize rs permit.orl <br /> motion I am providing <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing In this alauthorizedperson to have <br /> d, <br /> plication.I agree to permit county officials charged with administering county ordinances or other T g 4 <br /> r <br /> access to the above described premises at any reasonable time for the purpose of inspection. A <br /> y O <br /> SIGN HERE <br /> (signature of owner or buildin ontractor) <br /> ZONING ADMINISTRATOR � T <br /> 177,O /7N N <br /> TOWNSHIP PERMITS MAY 3E REQUIRED JUL a w ( rn <br /> 609860 $ 90omu) <br /> TI <br /> HI <br /> –OVER – <br />