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60 C-ony <br /> County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator Wo <br /> -APPLICATION FOR — LAND USE — PERMITS m o <br /> E ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and o c C <br /> A as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the p� <br /> ,eft County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and $ <br /> 0 <br /> ulations of the State of Wisconsin. w m <br /> m O <br /> �.! <br /> / TELEPHONE <br /> WNER �086R C'Ar4c'L �o(Z `�$q- Z.17'1 0 <br /> ADDRESS 3gss c-6-a-rczJlu RD ST. PAUL M4 . 5S121 a {� <br />:MERGENCY/FIRE NUMBER ROAD NAME <br /> I <br /> EGAL DESCRIPTION (sae tax receipt) <br /> 1 <br />)ONTRACTOR <br /> YPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o V <br /> \ O <br /> iANITARY /� PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION p < <br /> a r- <br /> 0 <br />>TRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) oz o n I <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 3 r <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). It ^ <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 .4 I-..V <br /> measurement to the ordinary high water mark of lake,stream, or river. O li <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A 3 to <br /> Z c <br /> PLOT PLAN ° n <br /> C ' <br /> c <br /> r N <br /> O <br /> N <br /> O <br /> J <br /> O y <br /> w <br /> Z <br /> i <br /> F <br /> CONDITIONS OF PERMIT: C g ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e ! 'Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. tgo` ` p <br /> m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> a S <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know[- '. O e m <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- m <br /> tion contained in this application(Including any accompanying schedule)and I turther declare that I recognize that this infor• O <br /> mation I am providing will be rolled upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ $ <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 <br /> access to the above described premisaa at any reasonable time for the purpose of Inspection. r <br /> r <br /> Z. <br /> SIGN HERE <br /> (sign re of owner or bull Ing contractor) (date) <br /> ZONING ADMINISTRATOR ,7Sro,41 � �'( <br /> TOWNSHIP PERMITS MAY BE REQUIRED 'N m <br /> 48 808 9,$'8 y <br />