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� "3 <br /> K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 Z. <br /> - PERMITS 3. ' <br /> ATION FOR - LAND USE = ° <br /> it for the work described and <br /> R:The undersigned hereby makes application for a Perm <br /> iersigned agrees that all work shall be done in accordance with the requirements of the <br /> O Ordinances and the laws and 3. o <br /> nce,Sanitation Code,and with all other applicable County m <br /> nsin. a f <br /> TELEPHONE (715) 866-4215 0 <br /> d <br /> East ga,h Lake Road, Web'steA, WI 54893 m <br /> ADDRESS V \ <br /> ca5 ROAD NAME E"t Bah-0 Lake Road <br /> EMERGENCY/FIRE NUMBER O CO •P- <br /> 58, GL.2, Section 24, T38N, Ri6W, <br /> . <br /> LEGAL DESCRIPTION (see tax receipt) Lot 1 CSM Vol. 91 p9. own o. eenon <br /> w <br /> CONTRACTOR <br /> GARAGEIACCESSORY STRUCTURE <br /> ADDITION <br /> TYPE OF PERMIT(S): DWELLING/BUILDING <br /> 0 o <br /> SUBDIVISION ° `o <br /> FILLCAMPING UNIT <br /> SANITARY X PRIW ING/GRADING u <br /> 0 <br /> v <br /> STRUCTURE/ADDITION USE: SanitaA( on.? Z o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o a <br /> m <br /> 3 <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 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 O <br /> measurement to the ordinary high we ter mark of lake, stream,or river. Q <br /> 4. 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. 3 <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ON VERIFICATION BEFORE A PER <br /> CAN BE ISSUED. Z c I <br /> o n <br /> PLOT PLAN III o <br /> C i o <br /> a � <br /> SEE ATTACHED <br /> ry <br /> 0 <br /> n <br /> R <br /> N <br /> Z <br /> < <br /> m c-0c (n ate • <br /> 0 <br /> CONDITIONS OF PERMIT. p f 0 : T m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. O n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 1: o' g <br /> J: e,00 <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and taccuracyo the bestof of my knowl- 0 : � � o <br /> edge and belief it is true, cat on(including any acrompanyd complete.I gng schedule)and I furtherre that I am responsible rdeclare the 18that Iil drecogn ie that lthis infor <br /> tion contained in this app <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g� o <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 th providing to this ap- « <br /> T 0 <br /> plication. I agree liability <br /> permit county y be <br /> charged with administering county ordinances or other authorized parson to have m t to o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m H $ . <br /> 5/16/93 « se <br /> « � : : <br /> i <br /> 4'dSIGN HERE (signature of ownsrb c trot) rL <br /> 8 <br /> ZONING ADMINISTRATOR { N N W N N««J <br /> l�f�) I o ur m rn rn m o <br /> TO SHIP PERMITS MAY BE REQUIRED <br />