2010/06/22 - LAND USE - LUP - Other

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Cro O Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a APPLICATION FOR LAND USE PERMITS o OWNER Q TELEPHONE o. /Clic � �l�C/ 'JIS-(a57i33`lS 0 MAILING ADDRESS 55G l rra,�er �d bko fires *t) ssat,� (5/-y8le h PROPERTY ADDRESS r]�Q � Q/ n LEGAL DESCRIPTION TYPE OF PERMrr(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ 41irW GARAGE/ACCESSORY STRUCTURE ❑ . r BUNKHOUSE ❑ 5"42(11C)GAVB€Y� STAIRS FILLING/GRADING ❑ CAMPING UNIT ❑ COMMERCIAL BUILDING ❑�{ COMMERCIAL ADDIT/1IION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ STRUCTURE/ADDITION USE: `� S't'Gt//'C✓ J Aac95- 60Y'""" G o (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) BUILDING CONTRACTOR: O � A PLOT PLAN MUST BE PROVIDED ON AN B rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C c WILL BE RETURNED. ify DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) V �y 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 p7 00 3 BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, p AND INDICATE NORTH (N). N z 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDING(S) g ° 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. p 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES 5. TO BUILDINGS, ROADS, LAKE, LOT LINES. w 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 w o PLANS MUST BE SIGNED AND DATED BY THE OWNER. (�7� NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN y i NEEDED. THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: CJ I 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. E A Q 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER SETBACK AREA. J 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. NOT TO BE USED FOR HUMANHABITATION. 6. ter • al(64aQ,� 7. /U� e clot �f/�n �r{v �A�k rMvlT�l n z n c I declare that this application (Including any accompanying schedule)has been examined by me and to the best of my B 0 ,� E.8_' e knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detall and accuracy of all ' 5P_ P_ $ y Information contained In this application(including any accompanying schedule)and I further declare that I recognize that this _. > > W N Y Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I v c aw'v 'l further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this Q S application. I agree to permit courprrcials chargewith administrating county ordinances or other authorized person to ^ n °?' o : o o have access to the above-descrlb emisas at aDoeasonable time for the purpose of inspection. .'wNo Y OWNER'S SIGNATURE S g g o S o y date) > Ip n y p C7 ZONING ADMINISTRATOR Jim I l $ZQ1 o s n ry�y AL �y TOWNSHIP PERMITS MAY BE REQUIRED THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCEBURNM g P�(rrtii Ie-��er�1c�ed �p bq b�ia,, V� -iew � 6 1 $9.•• pN by i�IF�