2012/03/27 - LAND USE - LUP - Other

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h ° Z Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator APPLICATION FOR LAND USE PERMITS H OWNER -� TELEPHONE MAILING ADDRESSVJ L_Jl V PROPERTY ADDRESS O A G o ( LEGAL DESCRIPTION tVY''1 � � Z x t�`f3 Zoct' �� ciL O ) {-Z o -F# td I I F"3l Z Qv TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ (ARAG /ACCESSORY STRUCTURE 1K cn BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ a COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ r' ° STRUCTURE/ADDITION USE: -1-- C'7(-0I�c�L_ (Home/Cabin; Aopm�mercial Business; Bedroom; Deck; etc.) BUILDING CONTRACTOR: ? L1.t Ctt�tEX o � A PLOT PLAN MUST BE PROVIDED ON AN 8 rk X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o_ WILL BE RETURNED. DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) rnn 0 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ^ d 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a AND INDICATE NORTH (N). I o I Z 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 S (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p 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. 70 J NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN NEEDED. THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r- 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. .z 0 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. A 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 4. NO STRUCTURES, INCLUDING RETAINING WALT-S, ETC., ALLOWED WITHIN THE REQUIRED WATER SETBACK AREA. W 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. NOT TO BE USED FOR HUMAN HABITATION. 6. 7. > >Ei oro 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 u w' rn :•9 Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this `° `- D > m Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I a A $ further accept all liability that 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 administrating county ordinances or other authorized person to have a v access to the above-described premises at any reasonable time for the purpose of Inspection. m w > � oo ooy OWNER'S SIGNATURE .. �rYV — c .A. R dry r� 6z > .: Ca nbv+ -n ZONING ADMINISTRATOR y vIN H ° H °n MAR 27 2012 TOWNSHIP PERMITS MAY BE REQUIRED THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF TaT COUNTY 00000 ZONING