1996/07/03 - LAND USE - LUP - Other (9)

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cyl e4 Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator a _o 0 APPLICATION FOR LAND USE PERMITS a � o TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work v 0 -CIS described and located as shown herein. The undersigned agrees that all work shall be done in actor- (D dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other v applicable County Ordinances and the laws and//regulations of the State of Wisconsin. A W OWNER /� Po/a TELEPHONE CD HOME ADDRESS I� /✓C \ O EMERGENCY/FIRE NUMBER /'F19 ROAD NAME ; 1 f / , LEGAL DESCRIPTION(see tax receipt) C L /• L � �C,� � �3 �� /)�� ,_ w' CONTRACTOR e � � o TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION 0 m O O SANITARY PRIVY FILLIN/G/GRADING CAMPING UNIT_ SSUUUBDIVISION o v STRUCTURE/ADDITION USE: Oa /t CG r K JX 1, 9G fQr� ,c._f d2t- 'Cd (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) 04041O tu* r 0 A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. n X C-) �. DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 m a cn m o a 1. All required dimensions or distances to be shown or drawn to scale. 0 2. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate m N: North (N). m O 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of W road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. 10 4. Show the location of the well(W), septic tank(ST)and drainfield (DF), and all distances to buildings, i roads, lake, lot lines. �. 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 plans must be n signed and dated by the owner. ( C a NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- FORE A PERMIT CAN BE ISSUED. THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. C O CONDITIONS OF PERMIT: g 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W ISSUANCE. 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 9 PERMITTED. 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE \ OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. 5. 6. 7. �e /1GllCd �KJ � )9Z, M. QaMFL 47naF m m lCD N. N O =fm .0. W O_ 8. o f !m. ID 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my ; m knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of i'u �„' p all information contained in this application(including any accompanying schedule)and I further declare that I recognize o o that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 0 0. o : o ; sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information I am n p providing in this application. I agree to permit county officials charged with administering county ordinances or other ? 3 i 8 authorized person to have access to the above described remises at an reasonable time for the purpose of Inspection. v y i P P Y P P P.— (D SIGN HERE u.-- _ / ( no of owns or�ulld�ingicontractor)(,(M, Qo„y{ Rj 004Ll pp (date) g ZONING ADMINISTRATOR tns»�tflt»t»j' II l 'lt ♦ NN (nNNNN m TOWNSHIP PERMITS MAY BE REQUIRED 0000 0 0 o m 000000011)