2010/08/06 - LAND USE - LUP - Other

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C � Z Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g APPLICATION FOR LAND USE PERMITS a Q -f W OWNER ' /O/_ L, I��`S©1�1 TELEPHONE 7�J �` ° - `�� = a 6 W(. Y � '1 A_� C; J MAILING ADDRESS •'l ELL �'D� /h .I f?V L> / ( 00 Ol ^ r'f/V t7 Y Wf PROPERTY ADDRESS M13 /V)i/ K��L.� R. r 3 '��n V R,/ "p� o I I P LEGAL DESCRIPTION L O r 1 Z C 5m V �` Sy G 0 V LUT G a TYPE OF PERMrT(S): SINGLE-FAMILY DWELLING ❑ ADDITION Cl DECK ❑ GARAGE ACCESSORY STRUCTURE BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ I COMMERCIAL BUILDING ('`❑-� pCOMMO COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ STRUCTURE/ADDITION USE: STD R f 6 S��-f✓ ;• Z 0 (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) BUILDING CONTRACTOR: n 77 _ w A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C0 _ CX BE RETURNED. DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) o 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. G K 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW 9 BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 01) AND INDICATE NORTH (N). 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) v) ° TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. , p 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES TO BUILDINGS, ROADS, LAKE, LOT LINES. I v, 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE 71r-� o PLANS MUST BE SIGNED AND DATED BY THE OWNER. NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN47— i y NEEDED. 1 I THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: �N 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z C 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. [; 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER SETBACK AREA. 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. NOT TO BE USED FOR HUMAN HABITATION. :E 6. 7. 0 0 0 n I dedare that this application(induding any accompanying schedule)has been examined by me and to the best of my y o,°2 99 knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m C EL 2 information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this D 9 m `O Information I am providing will be relied upon by the County of Burrett Wisconsin In determining whether to Issue a permit. I L,,��, a w'= Y further accept all liability that may be a result of the County of Burrett relying on this Information I am providing In this application. I agree to permit countyofficials charged with administrating county ordinances or other authorized person to have access to the above-described �19seat any reasonable time for the purpose of Inspection. w 8 i„A.� r1 aow � o $ a OWNER'S SIGNATURE y, n o n e= 2 (date) ZONING ADMINISTRATOR A o n Cil TOWNSHIP PERMITS MAY BE REQUIRED ` THIS PERMIT SHALLEXPIREONE YEAR �FROM DATE OF ISSUANCE -P4Ml. 4- �e+?-V� , p &-ed 41CIJ I�j K�05Lr IJ4?Wt\ 8-3-10