1996/05/28 - LAND USE - LUP - Other

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IN C2)-Ap Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 APPLICATION FOR LAND USE PERMITS 3. TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work � N described and located as shown herein. The undersigned agrees that all work shall be done inactor- m dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. H OWNER Tc,\ + YN,\\ VV-1 e TELEPHONE a HOME ADDRESS 1l I r1 1 i lJ a,� '1 0 se Do��e r- �, ( S y go I 1 EMERGENCY/FIRE NUMBER \ \ r�6 ROAD NAME Nwl —10 LEGAL DESCRIPTION(see tax receipt) S 3(o ( 3 q R l y w AGR 2 S 3 5, o w S� yy CONTRACTOR yTYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ADDITION � 0 N O SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION - Z ° i \ a STRUCTURE/ADDITION USE: SMC 05'--' A �vt'c-� j �ntiT('�A L-.-) RV\ 14 � (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) r ° A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. In O DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 T ? y 1. All required dimensions or distances to be shown or drawn to scale. o a 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate m H: North (N). C 0 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m road, (c) building(s) measurement to the ordinary high water mark(OHWM) of lake, stream or river. r 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildings, roads, lake, lot lines. 5. Indicate if a walkout basement is planned and show areas to be graded or filled. }F�1y1 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be signed and dated by the owner. (n (� 2 NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ;of a FORE A PERMIT CAN BE ISSUED. nr�di 0 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. 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Y1 ? PERMITTED. (� ' 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE /}J OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. 5. f 6. (dr/�V rnr DD V o' o ? W0 8. m $ f I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my knowledge and belief it is true,correct and complete. I acknowledge that I am res m g p g responsible for the detail and accuracy of i �{ �E O 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- c : 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 [) p' providing in this application. I agree to permit county officials charged with administering county ordinances or other ; 3 ig authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. SIGN HERE qin C� 11-.�1. 1J` JC \ -J (slgnatusy,of ow9pr or building contractor) (date) [ $ [ ZONING ADMINISTRATOR \ Irl �fn f»�tn fn tn� -n M TOWNSHIP PERMITS MAY BE REQUIRED 000g0000 (A