2009/09/25 - LAND USE - LUP - Other (3)

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V V Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g 3 APPLICATION FOR LAND USE PERMITS y cc OWNER p EE TELEPHONE �_7rS- S'3S3a = o MAILING ADDRESS fr� E�4� 1p)iR E N/1 S SZI O w PROPERTY ADDRESS a&_lfJ-3 _IU ,C I Vl j-Q� �L o �a LEGAL DESCRIPTION D�'lD+l_ -�()O /PH 66V 1b1 �6- 39 �� \ TYPE OF PERMIT(S): SINGLE FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ I G(ARAGE/ACCESSORY S RUCTURE BUNKHOUSE ❑ 59.692(1V)GAZEBO C STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ A COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ a � STRUCTURE/ADDITION USE: r I lak (Home/Cabin ommercial Business; Bed oom; Deck; etc.) - r1�• BUILDING CONTRACTOR: O � A PLOT PLAN MUST BE PROVIDED ON AN 8 Y:X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o WILL BE RETURNED. n a DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m b 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 71 BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, AND INDICATE NORTH (N). o 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w' O (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 TO BUILDINGS, ROADS, LAKE, LOT LINES. 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 o PLANS MUST BE SIGNED AND DATED BY THE OWNER. "I 01 NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN O' NEEDED. THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z O 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. B 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. V 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER SETBACK AREA. S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. NOT TO BE USED FOR HUMAN HABITATION. 6. 7 py annnpp; ao •e s n n I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my g o,°2 i,.n g.S?w q knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this c➢ a a ti Y Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I - a m, •d further accept all liability that may be a result of the County of Burnett retying on this Information I am providing In this appllcation. I agree to penult county officials charged with administrating county ordinances or other authorized person to have ,o w' o o 3 r access to the above-described premises at a e time for the ose of Inspection. ca w a o�4 N o o j > 00000 ,� A d d OWNER'S Si (date) �$ ` 3 A = 2 i F[ n� a ZONING ADMINISTRATOR �l�Y� Q--� n k TOWNSHIP PERMITS MAY BE REQUIRED c THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ^H Pernit p�GkeG( aa-D E � � s000g J