2008/07/03 - LAND USE - LUP - Other (3)

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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator ° APPLICATION FOR LAND USE PERMITS y G' (JJ � n OWNER ,Sam 64,aRlla r„/ TELEPHONE A� MAILING ADDRESS �1Q/-�� /l � � � PROPERTY ADDRESS UU V 6 a�g LEGAL DESCRIPTION o O( TYPE OFPERMIT(S): SINGLE-FAMILY DWELLING\0 ADDITION 11 DECK❑ GARAGE/ACCESSORY STRUCTURE ❑ ? [� BUNKHOUSE❑ 59.692(1V)GAZEBO j$ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ STRUCTURE/ADDITION USE: 5'J- (0 ?a (/ V) Q � hon2l las2dT s �h�e�6ac� (Home/Cabin; Commercial Business; Bedroo c; Deck; etc.) 0 BUILDING CONTRACTOR: 0� d O 4 p�� A PLOT PLAN MUST BE PROVIDED ON AN 8 1/1 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C < r WILL BE RETURNED. _ DIRECRONS FOR PLOT PLAN DRAWING: (AREAL OR TOP VIEW) 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c d 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW 3 BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, .a AND INDICATE NORTH(N). i z 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S) TO CENTERLINE OF ROAD,(C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES O G) TO BUILDINGS,ROADS, LAKE, LOT LINES. 5. ti fi tQ` S. 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 c _s� PLANS MUST BE SIGNED AND DATED BY THE OWNER. CN d NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN NEEDED. Q THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: O 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n O 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 C SETBACK AREA. (q v 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. NOT TO BE IISED FOR HUMAN HABITFpTION. 6. (HkS� fflll of J9 10v� u)1 J1 ploinFit j plQ.n og4vLed bV LAO,d4kJakr 7. f�di�'or�l la�dinJS n.-k 'MU-St-be 2 351 from D- N TiJ- m fi y05EI va l 33 -. _ I I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge 3 0 6 5 K 3 ? 5 and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information contained in this application(including any accompanying schedule)and S further declare that I recognize that this information I o c. D 9 m N am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit I further accept all �� R a w" liability that may be a result of the County of Burnett relying on this information I am providing in this application. I agree to ^ p-� d,N z i c permit county officials charged with administrating cou ordinances or other author person to have access to the above- rr described premises at any reasonable time r the pu of inspection W� $$w N w 3 K7 " y8 $ o88 OWNER'S SIGNATURE °'°a' (date) o > m C7 °1 r {f��a -o o6c ZONING ADMINISTRATORy �I l I ('%) �.n 'Z U� °E, w' o �y :P TOWNSHIP PERMITS MAY BE REQUIRED a O THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE Io " SO808 erm; �- .+- lei--�-2.�' �rckeal �.� �� S'am G�,r.R 1 t��d e �3 - 0 �