1996/03/21 - LAND USE - LUP - Other - 19229

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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator co ; 0 0 APPLICATION FOR LAND USE PERMITS 2. w 3 o TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for tir a work y described and located as shown herein. The undersigned agrees that all work shall be done in accor- dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with a II other - o applicable County Ordinances and the laws and regulations of the State of Wisconsin. OWNER Lf}��D L £R IGKS 0 AI TELEPHONE 715_ 1,8'1 2,7 fC m HOME ADDRESS a��y5 Ak�RM�kK /PD 7 EMERGENCY/FIRE NUMBER a.a S/s' ROAD NAME �-kE P/Lj f 4'g I LEGAL DESCRIPTION(see tax receipt) Gew T S�G 3f/ T;*r/✓ CONTRACTOR m G1 TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION m y O O SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o (� m STRUCTURE/ADDITION USE: 6,foxE Shp (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) r 0 A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE R ILLEGIBLE PLOT PLANS WILL BE RETURNED. T O DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 T 'R y 1. All required dimensions or distances to be shown or drawn to scale. p o a 2. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate m y: North (N). (a 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerli ie of m � road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or r ver. lR 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to builc ings, roads, lake, lot lines. 5. Indicate if a walkout basement is planned and show areas to be graded or filled. c) 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans mu t be a signed and dated by the owner. CJD U) NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION E- ° FORE A PERMIT CAN BE ISSUED. 2. ` 1 THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. CONDITIONS OF PERMIT: o 3. 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERM T ISSUANCE. 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOREL NE. 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY D PERMITTED. 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. 5. f 6. Nmvm DDy 9 m 7. _.m M o f Lez E E 1 8. o —N m� i Q o I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i E knowledge and belief It is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m rd'„ i O all information contained in this application(including any accompanying schedule)and I further declare that Icognize o o that this information I am providing will be rolled upon by the County of Burnett Wisconsin in determining whet ler to is- o : 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 providing in this application. I agree to permit county officials charged with administering county ordinances or other ': 3 ; 8 authorized person to have access to the above described premises at any reasonable time for the purpose of Ins pectlon. SIGN HERE (a ture of mner Qr building contractor) (date) o E E o ZONING ADMINISTRATOR TOWNSHIP PERMITS MAY BE REQUIRED p u u o v " . a In 00000000 ill