2012/08/27 - LAND USE - LUP - Other

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Burnett County7410 County Road K, No. 102, Siren, WI 54872 Cfficeofm-,qQWflgTX&S1 ANNEo APPLICATION FOR LAND USE PERMITS a = y w -O N OWNER /y,L=ON �� lCf•�E�-r TELEPHONE �nJ D�C�tI o MAILING ADDRESS •/ J n ' , T /V U /40), PROPERTY ADDRESS 9 7Q LEGAL DESCRIPTION 7 / CJ .CDT %� LARADRdB� S.isa /I ✓rsPot/ �i0 V/act o TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ DITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ v. BUNKHOUSE ❑ 59.692(1V)GAZEBO D STAIRS FILLING/GRADING ❑ CAMPING UNIT ❑ COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ r � ,1 0 STRUCTURE/ADDITION USE: Redf _�tcL�/jQ/l� (Home/— a(�mmeraal Business; Bedroom; Deck; etc.) BUILDING CONTRACTOR: �� E O A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C 0 WILL BE RETURNED, - A DIRECTIONS FOR PLOT PIAN DRAWING: (ARIAL OR TOP VIEW) n a 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r- 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 01 AND INDICATE NORTH (N). Z 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) No ' TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK -�. (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. l 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES t TO BUILDINGS, ROADS, LAKE, LOT LINES. WC F 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 PLANS MUST BE SIGNED AND DATED BY THE OWNER. 1U1J' 3 NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN I) NEEDED. 1 IY'jA 1 THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Ul r 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 9i ,z 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER d SETBACK AREA. ^, 1 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. NOT TO�BBE""USED FOR HUMAN Hg BITATION. 6' ��/3 � r ve�p('e of -, JAd 17 . r e r�aa:f`-06U4,e �- 7. 57 S -1� 4A4? w•t� Pock (2Lp PA- A•iaue Of/40• . Q/ul2F z �m�f cY. � ao 0 0 mad 'V I declare that this application(Including any accompanying schedule)has been examined of r t and to the best o my 3 knowledge and belief It is true,comet[and complete. [acknowledge that I am responsible for the detail and accuracy of all O g Information I am providing di this application(including any accompanying schedule)and I further declare that I recognize that this 5. a > m N Information I am providing will a relied upon by the County of Burrett Wisconsin In determining whether to Issue a permit. I .� 5- A further accept all liability that may be a result of the County of Burrett relying on this Information I am providing in this T.- application. I agree to permit county officials charged with administrating county ordinances or other authorized person t have access to the above-described premises at any reasonable tipe for the purpose of Inspection. m a o o ti w, f1 N fR qd > o 0 0 0 0 OWNER'S SIGNATURE m n n 0 ZONING ADMINISTRATOR -1 m TOWNSHIP PERMITS MAY BE REQUIRED THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N N o N N N o 0000 �