1996/06/19 - LAND USE - LUP - Other (11)

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aZ cam? Burnett Grounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator w -, 0 0 APPLICATION FOR LAND USE PERMITS 5 3. e TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit forth s work � � P described and located as shown herein. The undersigned agrees that all work shall be done in Icor- 3' dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with al other y I applicable County Ordinances and the laws and regulations of the State of Wisconsin. y 0 OWNER ! t7 TELEPHONE ��a, o fi /tCdd m HOME ADDRESS 6;w41, 41 Sn EMERGENCY/FIRE NUMBER b ROAD NAME d' LEGAL DESCRIPTION(see tax receipt) 77.PCL G / c- X37 CONTRACTOR / o TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION y r C7 o SANITARY PRIVY FILLING/GRADING CAMPING UNIT i SUBDIVISION o STRUCTURE/ADDITION USE: R Deck - S.� �1 (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) 0 A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE O ILLEGIBLE PLOT PLANS WILL BE RETURNED. .n O DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) A S) O 3 'n a y 1. All required dimensions or distances to be shown or drawn to scale. n o a 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate m CQ N. North (N). m L g 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerlin of road, (c) building(s) measurement to the ordinary high water mark(OHWM) of lake, stream or rivi ir. C R 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildin s, 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 e signed and dated by the owner. 11 y 2 NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE a FORE A PERMIT CAN BE ISSUED. THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. CONDITIONS OF PERMIT: o N � 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT a � ISSUANCE. 1 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY /� ? PERMITTED. 1 9 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OFT E OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. 5. 6. 'fee /' (Am -0mr D M 7. C: 0. 5' E G,tri, Z N O O,p m O fCz � v'E = m v c 'm a : O SZ3 � ' I declare that this application (Including any accompanying schedule) has been examined by me and to the bestf my m knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accu 'Cy of all information contained In this application(Including any accompanying schedule)and I further declare that I recc gnize E omm o that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is. o g sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this informatio I am 0: p providing In this application. I agree to permit county officials charged with administering county ordinances or other 8 authorized person to have access to the above described premises at any reasonable time for the purpose of Inspoi tion. r E c m E m SIGN HERE .G[clrb..c .GcGGR� H K (signs of wrier ding contractor) Ids)" r5 1 o ZONING ADMINISTRATOR O N N N N N N N m TOWNSHIP PERMITS MAY BE REQUIRE o 0 0 0 0 0 o it 000g0000 to