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lett rcunty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br />APPLICATION FOR — LAND USE — PERMITS <br />-IE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <br />)d as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br />att County Land Use Ordinance, Sanitation Code, and with all other applicable Count-; Ordinances and the laws and <br />3tions of the State of Wisconsin. <br />i <br />' ( 6'1 2 ) 770='5943 ( W ) <br />:R DANIEL L. ROSSOW/LINDA D. LEMAY TELEPHONE ( 612 488-2476 h <br />ESS 295 TOPPING STREET, ST. PAUL, MN 55117 <br />GENCY/FIRE NUMBER 2837/5 ROAD NAME FONTAINE ROAD <br />_ DESCRIPTION (see tax receipt) <br />RACTOR <br />OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE X ADDITION <br />ARY PRIVY FILLING/GRADING X CAMPING UNIT SUBDIVISION <br />-TURE/ADDITION USE: ATTACH GARAGE ARD POSSIBLE CHANGE TO WALKOUT <br />(Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />CTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br />iow the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br />iow the location of the well (W), septic tank (ST), and drainfieid (DF). <br />tow dimensions in feet of the following: (a) building to all lot lines, (b) building to center line of road, (c) building <br />?asurement to the ordinary high water mark of lake, stream, or river. <br />separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be signed and <br />ted by the owner. <br />: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE SSUED. <br />T PLAN <br />co <br />yri v R r P RmP. <br />Dip _r <br />35-1 <br />64/ A l F a f <br />�al GA2 �rve <br />�p <br />GA�� �� x`'14/ <br />/ ✓ 1 <br />o (? XC <br />CA 6('41 174h/ <br />1v f 7� <br />CD <br />Vl <br />C <br />C <br />m <br />a <br />v <br />w <br />T <br />0 <br />f <br />0 <br />o c m m chi a g <br />co• <br />mm <br />'-•n y am 3J <br />3 <br />< ,<—,' <br />m <br />DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br />o <br />21 _+ <br />N <br />_ REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br />`• <br />= : '• <br />'• O ` <br />NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br />n <br />E 0 <br />)clare that this application (including any accompanying schedule) has been examined by me end to the best of my knowl- <br />inforr,ia- <br />o <br />CD <br />and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and socuracy of all <br />ie <br />i contained in this application (including any accompanying schedule) and I further declare that I recognize that this infor- <br />o (n <br />tion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br />ther accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap- <br />S <br />.ation. I agree to permit county officials charged with administering county ordinances or other authorized person to have <br />I <br />p <br />Gess to the above described premises at any reasonable time for the purpose of inspection. <br />N <br />3 x; <br />i— <br />/. <br />mCD <br />v a <br />�Tt <br />� <br />$ <br />QO <br />o 'Ft <br />NING ADMINISTRATOR <br />TOWNSHIP PERMITS MAY BE REAUIRED <br />i fA to iR (fl -n <br />`^n M O (`n O 0 000' m <br />C6>99 88888 in <br />N <br />n <br />Z <br />o c m m chi a g <br />co• <br />mm <br />'-•n y am 3J <br />'ONDITIONS OF PERViT; <br />< ,<—,' <br />m <br />DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br />o <br />21 _+ <br />N <br />_ REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br />`• <br />= : '• <br />'• O ` <br />NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br />b ; <br />E 0 <br />)clare that this application (including any accompanying schedule) has been examined by me end to the best of my knowl- <br />inforr,ia- <br />o <br />m m C <br />and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and socuracy of all <br />ie <br />i contained in this application (including any accompanying schedule) and I further declare that I recognize that this infor- <br />o (n <br />tion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br />ther accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap- <br />.ation. I agree to permit county officials charged with administering county ordinances or other authorized person to have <br />I <br />p <br />Gess to the above described premises at any reasonable time for the purpose of inspection. <br />tet: <br />3 x; <br />i— <br />/. <br />mCD <br />v a <br />iN HERE <br />(signature of owner or building contractor) (date) <br />$ <br />o 'Ft <br />NING ADMINISTRATOR <br />TOWNSHIP PERMITS MAY BE REAUIRED <br />i fA to iR (fl -n <br />`^n M O (`n O 0 000' m <br />C6>99 88888 in <br />