2007/06/11 - LAND USE - LUP - Other

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Bumett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator c APPLICATION FOR LAND USE PERMITS s SO C, 6 OWNER II Lv 5Ll,j�l•� TELEPHONE /L1-2)— "� P u G MAILING ADDRESS /_ Za 13-f' Ave . NE, A4iAA4x&43/ AW SS"r[5 PROPERTY ADDRESS G 9i i7? 7( l n LEGAL DESCRIPTION Pct (VW yV S EY& (5S+G Ci) Se-&06 T39N�k I w (D SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSURY STRUCTURE ❑ ADDITIONIX STAIRS ❑ o_ T TYPE OF PERMIT(S): FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK '3 STRUCTURE/ADDITION USE: C,ZI�t17 A 6 �-1"`TION/ WTin C{1S�ilq� Pd z 14H�oome/Cab`in_rCommercial Business; edroom; Deck; etc.) �� o ° BUILDING CONTRACTOR: W1 1 Y'C4'- A PLOT PLAN MUST BE PROVIDED ON AN 8 Ya X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. F _ C - DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) r c 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW - BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, AND INDICATE NORTH (N). 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDINGS) o TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK e (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS, AND (D)LOT DIMENSIONS. H 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD(DF),AND ALL DISTANCES 2. TO BUILDINGS, ROADS, LAKE, LOT LINES. = O 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 _ OQ PLANS MUST BE SIGNED AND DATED BY THE OWNER. - t —1 W NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSRE VERIFICATION MY BE DONE WHEN W W NEEDED. I ,� THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z C) C 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQU REMENTS WITHIN 60 DAYS OF PERMIT. 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n Cn 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER SETBACK AREA. 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. NOT TO BE USED FOR HUMAN HABITATION. 6. n/o S A-GyC io2 I n.I 4 Ut p-IP-[a, Or' r.°w- - F >r s-> o 7. br � casz 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 responsible for the detail and accuracy of all information 17r c - ; D contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this information I .� M « a am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all liability that may be a result or the County of Burnett relying on this Information 1 am providing In this application. I agree to permit county officials charged with administrating county ordinances or other authorized person bo have access to the above- described premises at any reasonable time for the purpose of Inspection. F in y s _' > OWNER'S SIGNATURE (date) y c o .el Q e i w M ZONING ADMINISTRATOR '^ < S th 3Rp: TOWNSHIP PERMITS MAY BE REQUIRED THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCESO M x= �✓m;+-� 1Qt-lei ��led � CJI I bur S�h�l(i� � 4