2011/03/08 - LAND USE - LUP - Other

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C � z Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g APPLICATION FOR LAND USE PERMITS y N OWNER ////�� /n TELEPHONE � 6/l� '//� o —2_TV-0:3 w 6 MAILING ADDRESS i//.i/ �� ✓� eel �i ,SS�7 PROPERTY ADDRESS oZ711Z7 14W Si�a/G /C�ysa /� o i LEGAL DESCRIPTION or, TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO 0 STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ � U , COMMERCIAL BUILDING//D COMMERCIALADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ STRUCTURE/ADDITION USE: (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) �/ BUILDING CONTRACTOR: tp It — �v G A PLOT LAN MUST B PROVIDED ON AN 81/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. a DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 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 y BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, O 91 v AND INDICATE NORTH (N). o o 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) C TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK i (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. O 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF),AND ALL DISTANCES (p TO BUILDINGS, ROADS, LAKE, LOT LINES. ti 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE E PLANS MUST BE SIGNED AND DATED BY THE OWNER. 1 NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN \ y NEEDED. THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. rte. n z 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ] y 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. I d 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. d 6. '1S-foo2. 9rvre%� .Kt bo x. T be- WV6l 4 .3.6 IjVl'ne&F G.wt'( -.sr,...) �d+E tie T/m u. OF 561k,zvf' of �a� SEr cE�.✓e by Lhe S�weV�' yV'or-Eo CuN,n✓zu:.5 Ci+J6wt�w,... ^ n n n n > b 7. n 3 a Cr'1 m o p I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0,°� P P,: F . � : � knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m�.= information contained In this application(including any accompanying schedule)and I further declare that I recognize that this e q > c m ti l Information I 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 of th unty of Burnett relying on this information I am providing in this application. I agree to permit un ch ged Ith administrating county ordinances or other authorized Person[o have " y R o ? n access to the I bove-desc lb, emeses at any easo a ime for the purpose of inspection. OWNER'S SIGNATURE ` 101,241119. (date) JIM ��QI�I�i(Ah ZONING ADMINISTRATOR C�y c: TOWNSHIP PERMITS MAY BE REQUIRED THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE a= � � 80 �00 pe(fni,� �Izcl 4-o Friektll she . - 3 1/