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ON COMPUTER/SCANNED (y-n <br /> Bttmett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m o 0 0 <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 'Z - <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnen County' Land Use Ordinance,Saturation Code, and wah all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin, (' - o <br /> OWNER 6Ak 'RIDGE VAILF2 YN t TELEPHONE LJR� - 33% v -O <br /> ADDRESS 2 2� ON I W I A0 IJV I W. - 1 m <br /> EMERGENCY/FIRE NUMBER / ROAD NAME m <br /> 1 <br /> LEGAL DESCRIPTION (see 1.receipt) '� 9 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S) DWELLING/BUILDING_ GARAGE/ACCESSORY STRUCTURE_ ADDITION v �1 <br /> `y, 0 <br /> SANITARY /` PRNV FILLING/GRADING CAMPING UNIT SUBDIVISION = <br /> STRUCTURE/ADDITION USE: 5 <br /> (Home/Cabin:Commercial Business:Budroem:Deck:etc.) z o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) '(M1 {(h✓t,1 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). 0l <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feel 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 y <br /> dated by the owner. O o <br /> NOTE. BUILDINGSTRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. In 3o <br /> PLOT PLAN z <br /> 61 <br /> 4Tf R NO "' � I <br /> I I <br /> O <br /> i <br /> can <br /> 0 <br /> Z <br /> CONDITIONS OF PERMIT -"- — o-m-cIS C� -i-1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN e0 DAYS OF PERMIT ISSUANCE. o E <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ~ 4s T <br /> $ . B C � <br /> 1 deflate that this application ct ending any accompanying ge that I a has been examined to by m0 and to the to at 01 my forma p[ <br /> edge and belie)n i9 true.application <br /> l and complete.I acknowledge that am responsible for tae detail and accuracy h all is mf <br /> r n~: m <br /> Ilan contained in this application(including any a County of <br /> matt Wisconsin <br /> and I linnet eedareg w l thenrecognize that this iNoh $ o t7 <br /> mason ce providing will hi relied upon s the County of Burnen Wisconsin in determining int mma whether to issue a permit I <br /> pheaer accept all liability t c which may bci a result of tae County of Burnett relying on this information I am providing in this a e <br /> plication.I agree to permit county miseela ca y yea with administering county ordinances ti onset authorized parson to nrve ry a o <br /> 8Cta9!to the above described premlae9 at any 1e890Odbe time for the pOrpO3E of inspection. $ g mA <br /> F I <br /> SIGN HERE f r <br /> (si nature of owner ildi .fontract " 1 I��lot �v, � I Ir ' o <br /> �1 J n <br /> ZONING ADMINISTRATOR �� ��_�� /I`J <br /> ~' <br /> MAY 2 81993 TOWNS IP PERMITS MAY BE REQUIRED I�I a, " <br /> ( ItJU II.I U' a(Nn '8 � m <br /> IL, I ssssoss � . <br />