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'"�'��•�'^'••�. - 6Y'+.ea :le W' V]Y�k'.aa.Y.�idl�'41e. s..<`�� :�illhi'�l:a.. <br />. K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br />4TION FOR — LAND USE — PERMITS <br />1: The undersigned hereby makes application for a Permit for the work described and <br />resigned agrees that all work shall be done in accoidanc.e with the requirements of the <br />e, Sanitation Code, and with all other applicable County Ordinances and the laws and <br />n. <br />- (612)770r-5943 (w� <br />�W/LINDA D. LEMAY TELEPHONE ( 61 Z) 48� ?476 I1 <br />:SS 295 TOPPING STREET, ST. PAUL, MN 55117 <br />iENCY/FIRE NUMBER 28375 <br />DESCRIPTION (see tax receipt) <br />TACTOR <br />ROAD NAME FONTAINE ROAD <br />0 <br />)F PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE X ADDITION <br />,RY PRIVY FILLING/GRADING X CAMPING UNIT SUBDIVISION <br />TURE/ADDITION USE: ATTACH GARAGE AND POSSIBLE CHANGE TO WALKOUT <br />(Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />.TIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br />)w the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br />)w the location of the well (W), septic tank (ST), and drainfleld (DF). <br />iw dimensions in feet of the following: (a) building to all lot lines, (b) building to center line of road, (c) building <br />isdrement to the ordinary high water mark of lake, stream, or river. <br />1parate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be signed and <br />id by the owner. a <br />3UILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. <br />PLAN <br />0�' LI a%r <br />co <br />0 <br />N'— <br />Y4 &I? <br />AA it I, <br />3 Pf <br />'•j <br />1 <br />PRap, rNIS1<' Pao'.6SF <br />�ICn�t � evDip, � i 6.n6 I ti� QR <br />ayX30'/ouSti iaA4�i F <br />!]tib✓ir a <br />✓2 <br />II 4/0 <br />�! 0Q, <br />co <br />v <br />m <br />Lo <br />N <br />C <br />CD <br />a <br />v <br />m <br />Z <br />0 <br />OI <br />0 0 <br />3 <br />v <br />Z <br />o <br />M <br />C <br />N <br />M <br />0 <br />m <br />0 <br />y <br />2 <br />CD <br />Z <br />0 <br />0 <br />O <br />0 <br />r <br />0 <br />r <br />0 <br />0 <br />f <br />0 <br />CD0 <br />0 <br />OF YERfv%; : <br />M <br />� , � �7 9 <br />RIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF FERNiii ISSUANCE. <br />EMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br />— N <br />D GRADING OR si40RELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br />3 Yr,' <br />:' 2 ; ( rn <br />re that this application (including any accompanying schedule) has been examined by me dnd to the best of my knowl• <br />nd belief it is true, correct and complete. I acknowledge that I am responsible for the detail and ni:curacy of all informa• <br />S <br />C <br />ntained in this application (including any accompanying schedule) and I further declare that I re::ognize that this infor- <br />I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I <br />g m g <br />accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap- <br />on. I agree to permit county officials charged with administering county ordinances or other authorized person to have <br />E <br />s to the above described premises at any reasonable time for the purpose of inspection. <br />m <br />3 <br />wfi r / <br />x <br />T <br />N <br />+ r (signature of owner or building contractor) (date) . <br />g a <br />o <br />1NISTRATOR <br />o o <br />TOWNSHIP PERMITS MAY BE REOUIREG <br />�;' <br />m <br />QR�;RQRR�2rn <br />