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Loon Lzi-ke <br /> ,. ;KJ Po. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator Cn w ' -- Z <br /> APPLICATION FOR - LAND USE - PERMITS _ <br /> ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � & �n herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a' <br /> .(the State of Wisconsin. <br /> 0 <br /> rn w <br /> L N <br /> >/n I G /J ll 1'74 4 9 —��� TELEPHONE � � ,�'_ LI (� C o v O <br /> SS T D m <br /> 13 rJ Q M ,v ti i <br /> GENCY/FIRE NUMBER ROAD NAME <br /> DESCRIPTION (see tax receipt) <br /> s'tit L) 1 „ z -zi <br /> FACTOR ) 90- I, <br /> OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION X <br /> o _ <br /> aRY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION `-' o <br /> :TUBE/ADDITION USE: C R W o — �-- l N r- <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) / N� -0 o <br /> ;TIONS FOR PLOT PLAN DRAWING: (Aerial or top view) CD <br /> � ((4— <br /> ow the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> ow the location of the well septic tank S• �, p - ( T), and drainfield (DF). ° <br /> )w dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building <br /> isurement to the ordinary high water mark of lake,stream, or river. <br /> eparate plans are submitted by an architect,,engineer, budder, contractor,etc.,the plans must be signed and <br /> 'd.by the owner. <br /> n <br /> BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION•-BEFORE A'PERMIT CAN BE ISSUED. O ° <br /> In 3 <br /> PLAN �- _ o a <br /> �Q n <br /> 6/ <br /> P C�c� Nf <br /> L� k Ch r �e.-�� d �,2�- m <br /> i <br /> 0 <br /> I <br /> CD <br /> l o <br /> �� �✓l7 -� <br /> � . o c ;. sv m o Q- <br /> )ITIONS OF PERMIT: CD 2 a N 4 m rrl <br /> 0VEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m' o MOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ° ?!GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. v�i tj 2 m <br /> n . D e that this application(including any accompanying schedule)has been examined by me and to the best of my knowl• o m m C <br /> d belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> itained in this application(including any accompanying schedule)and I further declare that I recognize that this infor• °i " m <br /> I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I �'$ <br /> accept all liability which may be a result of the County of Burnett relying on this information I am rovidin o o <br /> 0 0 : <br /> n. I agree to permit county officials charged with administering county ordinances or other authorized person toiha have N) <br /> to the above described premises at any reasonable time for the purpose of inspection. ; m <br /> mERE cs��> --e� �rr �o N <br /> 1U �_ ►-1 �+ n o <br /> (signature ot.6wner or building contractor) <br /> ADMINISTRATOR '7 t o <br /> - g <br /> TOWNSHIP PERMITS MAY BE REQUI )AN 0 �ggq <br /> . c11eNiv m <br /> WiaNioc� cn <br /> ;1' 000bor, l, r, rn <br />