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

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C R Z Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator ° APPLICATION FOR LAND USE PERMITS H = OWNER �ObIf— V� I,(t v"y t y\ t` . Owe TELEPHONE �(Z _ �t3 -T 7-3 o MAILING ADDRESS (�/v4`�3 C`�4J �iGwy� Q4rY�, ��I tom. M rl 155-647 v l PROPERTY ADDRESS 7-g� s �trc\A �S�ko� LIn� �r 'iJgv�,7� SQ'g ) n 0 LEGA DESCRIPTION 'Qarc- —QO.r � (adj l.ok 3AG SE .,w (A4o(4 \Jotu e Sd L TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE 11 BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ v COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ o 3 STRUCTURE/ADDITION USE: t(Q yc (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) BUILDING CONTRACTOR: EGY— C c'^S�wc.'(iC'�n n O 3 A PLOT PLAN MUST BE PROVIDED ON AN B 'k X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C a WILL BE RETURNED. DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW Cn m v 3 BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, C> J 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 SU 5' (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. Od p 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK (ST)AND DRAINFIELD (DF),AND ALL DISTANCES SU R TO BUILDINGS, ROADS, LAKE, LOT LINES. 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. d__ 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE 1 o PLANS MUST BE SIGNED AND DATED BY THE OWNER. 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: 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. I l n z 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z 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. SU 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. NOT TO BE USED FOR HUMAN HABITATION. 6. 7. s yo 0 o nct77 I declare that this application(including an accompanyingschedule has been examined b me and to the best of m DP ( 9 Y ) Y Y knowledge and belle(It is true,correctand complete. I acknowledge that I am responsible for the detail and accuracy of all c to d = rn y Information contained In this application(including any accompanying schedule)and I further declare that I recognize that this 5. 9 9 m N Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I & ,��, 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 0 : o o r access to the above-described premises at any reasonable time for the purpose of Inspection. m a o w N o o j 3 n o 00 0 0 o y OWNER'S SIGNATURE 07//Z/j 2 ' j ' mn w±+ O (date) ZONING ADMINISTRATOR TOWNSHIP PERMITS MAY BE REQUIRED 8 °° THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE "N U , F "'