2012/03/21 - LAND USE - LUP - Other (3)

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C Z Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator Cr ° APPLICATION FOR LAND USE PERMITS y - OWNER �,AJ tI/,.�C� I//T-1 mTELEPHONEj� O MAILING ADDRESSF—Y J o{L- f((/ 14401v66, Jj PROPERTY ADDRESS 01,�>y7at0 1 R LEGAL DESCRIPTION D/Z — �jz� , Q G Lor /2 14t/&r4F( gs 3 Sc. 3S 7-40A)1?6WSadfun TYPE OF PERMrf(S): SINGLE-FAMILY DWELLING ❑ ADDITION DECKS GARAGE/ACCESSORY STRUCTURE ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ o STRUCTURE/ADDITION USE: /� � �«MYr.IC QV(65: 12 X ZO G/PTf. 5YI6" /¢Kit( � to (Home/CCaaabbinCommercial Business; Bedroom; Deck; etc.) BUILDING CONTRACTOR: ----, .--- n O A PLOT PLAN MUST BE PROVIDED ON AN 8 '/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o_ WILL 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. K 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a AND INDICATE NORTH (N). N o 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 3" (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 TO BUILDINGS, ROADS, LAKE, LOT LINES. 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 J) o PLANS MUST BE SIGNED AND DATED BY THE OWNER. NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN .6V ..I NEEDED. Ill , 01 (a1 W � THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z 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. S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. NO'I"TO BE USED FOR HUMAN HABITATION. ZE 6. CovtrpL 044 (dr-gs Eo 2..ua. O/k++. F)+ screGfs Iny or o&si tuap+ 4 6e, 64t4da. 7. '7y ^ o 0 o nao ^e H 3 I declare that this application(Including any accompanying schedule)has been examined of r t and to the best of cy 3 0.°Z 8 0 2 knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all c y ' _� d Information contained In this application(Including any accompanying schedule)and 1 further declare that I recognize that this 9 9 W Y Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I .� R a .p further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this c application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have ° .°2 0 0 o ,r. access to the above-described pre s at any reasonable tlm urpose of Inspection. S o R N fn«1 RC1 m rt a o w N wo a 3 A a a o 0 o g o OWNER'S SIGNATURE a fm >r» 6 0 td 3 b E _ z ^ ,^f ZONING ADMINISTRATOR A551`� `Z.A. � : m AR 15 2012 " TOW SHIP PERM S MAY BE REQUIRED ° THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUApIGE �NECOU ti DtJFt ZONING