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ty 7410 Co. Rd. K. No. 102, Siren, WI 54072 Office of Zoning Administrator y V s o 0 <br /> APPLICATION FOR — LAND USE — PERMITS ' <br /> s <br /> ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 n <br /> herein. The undersigned agrees that all work shall be done in accordance with the requirements of the a c <br /> ...,wumy Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ <br /> v <br /> regulations of the State of Wisconsin. <br /> rp ( i^,t �/ 1 c o <br /> OWNER L� i�'1 I V`a[t j �p2.�VH(f h��..It TELEPMHON��Plo7�—Ja�' �IO7.3 e � O <br /> ADDRESS'1 2d. <br /> EMERGENCY/FIRE NUMBER r S R ROAD NAME uT'KK 61 nJ. <br /> LEGAL DESCRIPTION (see tax receipt) N w• vJ <br /> CONTRACTOR <br /> Q <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION a 1- <br /> 0 <br /> SANITARY _ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` < <br /> m � <br /> STRUCTURE/ADDITION USE: ° o <br /> v <br /> Home/Cabin; ommerciel Business;Bedroom; Deck;etc.) o 0 <br /> v <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 (M,septic tank (ST), and drainf laid (DF). 3 <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. Q 11 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and a <br /> dated by the owner. Q <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMrr CAN BE ISSUED. o <br /> KEm <br /> Z a <br /> PLOT PLAN P n <br /> N <br /> � L <br /> a <br /> ra <br /> rL <br /> Im <br /> 0 <br /> s z <br /> d <br /> a <br /> v <br /> Z <br /> ( M <br /> r <br /> o, 2 –•a di r^� y <br /> CONDITIONS OF PERMrr: o _ : Cs g ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p 'z i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ` ` 30 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �` �"• ` G <br /> E ' f C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- S }�li}p� m <br /> i S a <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- O <br /> mation I am providing will be relied 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 promises at any reasonable time for the purpose of Inspection. T <br /> i <br /> SIGN HERE (dais) <br /> M`: <br /> (signature of owner or Ilding contractor) ( <br /> ZONING ADMINISTRATOR V I r C '• �'•+ $ '• E ` .. <br /> TOWNSHIPp)eY BE REQUIRED o ih' >$ II'� m <br /> 99 88188 y <br />