2011/09/20 - LAND USE - LUP - Other

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a Z Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g ° t APPLICATION FOR LAND USE PERMITS 4. �`� OWNER VatllA d'-Jttl He55dy-0th Sia'-� I? C. R TELEPHONE 7` ,7—,� ._a-5 Cw6�y O MAILING ADDRESS PROPERTY ADDRESS /G �G 7C y s�0"e ko W,2 b 5-k iN s 0 LEGAL DESCRIPTION 0-7— C)�a. TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ b COMMERCIAL BUILDING ❑ f�*�p'IMMI EpRCICAylL�yA�DDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ STRUCTURE/ADDITION USE: I 5) (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) BUILDING CONTRACTOR: IDQ f,It,,.1 11FV"-Llatrr A1C I J QT(C✓1 iso� � �i.z e 5 e o �OQ A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. c DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) tnn ^p 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ci 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, O '� l AND INDICATE NORTH (N). N 9 o 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) p $ TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5 o (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p O' 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES 51.1 TO BUILDINGS, ROADS, LAKE, LOT LINES. I n. rn 1 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 o PLANS MUST BE SIGNED AND DATED BY THE OWNER. 6, t n /wh NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN p) .�' I :1 NEEDED. J' (ply THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. p r) Y 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. U7 a 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER p — SETBACK AREA. , 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. ITIT NOT TO BE USED FOR HUMAN HABITATION. O 6. G 7. � 0 000 no>. oro 6 zo � � go 3 I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my g e '�l c, 6 8 knowledge and belief it Is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of all W E. Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this ._ �. > > m Y Information I am providing will be relled upon by the County of Burnett Wisconsin In detemllning whether to Issue a permit. I 5 ?- 7 i Ip further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this c y v,v, 22 „”, b application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have ° n ° access to the above-describedd premises at�any reasonable time for �the purpose of Inspection. OWNER'S SIGNATURE m r) Vi 9 0. w � E. c z /1 (dace) _ � ZONING ADMINISTRATOR y ° _ TOWNSHIP PERMITS MAY BE REQUIRED O THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE = S000S Pe�rn�+ je -eK pTCtedv p K1 aa W4-Tt l Nes�ra4i