2010/04/01 - LAND USE - LUP - Other

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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator APPLICATION FOR LAND USE PERMITS/� w OWNER�.�-,-I �n ()R. H ' (0 Z`7 Zz"�O� D n Gory 5he�dy / f Ia+ker TELEPHON CQ� nl Z &/�,O - S5`10 9 9J MAILING ADDRESS J�Z -l�s �. � mn �5 f�j '� � � 79 v PROPERTY ADDRESS 3 �l)G�to lk)e� IC6 , St Q.F'r1,� lNl 3,44 C) J / I LEGAL DESCRIPTION IO�(� i (1 O) r well:: TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO O STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ B COMMERCIAL BUILDING ❑ C�OMMMtRCLAL,ADD{�IT,ION O COMMERCIAL ACCESSORY STRUCTURE ❑ STRUCTURE/ADDITION USE: _I tO WI$�(`�� h \I"�� ✓`dd,' (DA)G(( ,�C�U'DUn2S'1I✓12�' ._(2C�CQ (Home/Cabin 6aaAwercial-business; Bedroom; Deck; etc.) p,-I ) C BUILDING CONTRACTOR: _ � I y 'I 3 A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPL WILL BE RETURNED, ETE OR ILLEGIBLE PLOT PLANS o p — H DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n °' 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C I O 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 9 AND INDICATE NORTH (N). 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 0 0 TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5' (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 K - Oa TO BUILDINGS;ROADS, LAKE, LOT LINES. - n. 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. y 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE o G PLANS MUST BE SIGNED AND DATED BY THE OWNER. a Qli NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN NEEDED. THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: W 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. O 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. a 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER N SE'1 BACK AREA. 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. NOT TO BE USED FOR HUMAN HABITATION. 6. must kje Cons -r-uC_4-ej Bons[gKc, lunrard >IDfvomdl-anF,Ud- ' 7. Zannnpna y xn 33310 ^ � I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 9 e knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all a d e Information contained In this application(Including any accompanying schedule)and I further declare that i recognize that this E. a D m ti Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I ? a u= further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this person to have N H=- in N b application. I agree to permit county officials charged with administrating county ordinances or other authorized p n° ^' dz gg: access gg [- to the above-described premises at any reasonable time for the purpose of Inspection. ^ a a W N a OWNER'S SIGNATURE :.(dat - 10 dao WO' .� =',2 ZONING ADMINISTRATOR_ til TOWNSHIP PERMITS MAY BE REQUIRED w THIS PERMIT SHALL EXPIRE ONE YEAR FROM D TE OF ISSUA CE P.e.r&-)�� d I e ke i m��e d kO 6�t y -4-S�hzr,