2015/03/30 - LAND USE - LUP - Other

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C t�D Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator APPLICATION FOR LAND USE PERMITS Q n OWNER dos epI� 1 /1 L rL ULL ( TELEPHONE MAILING ADDRESS L)I y Y`PA t L/Y a- PROPERTY ADDRESS � 1 LEGAL DESCRIPTION PA , �I T w o i°GL. E PC-cC niu VDL2Z C" ( � TYPE OF PERMIT(s): SINGLE-FAMILY DWELLING ❑ ADDITION DECK❑ GARAGE/ACCESSORY STRUCTURE m BUNKHOUSE ❑ 59.692(1V)GAZEBO❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ -o COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ STRUCTURE/ADDITION USE: L304 z (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) BUILDING CONTRACTOR: O o_ A PLOT PLAN MUST BE PROVIDED ON AN 8'/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o y WILL BE RETURNED. a n rn DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c 0 Q 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 o BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, t (� AND INDICATE NORTH(N). o 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 O (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. y' 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 PIANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE a PLANS MUST BE SIGNED AND DATED BY THE OWNER. t SCJ 1 NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DON NEEDED. I 5[J I THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: a-}�'aG4te �I � � n 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. (f lI 5� d z 2. REMOVAL OR CUTTING OF TREES AND VEGETATION I5 RESTRICTED ALONG SHORELINE. 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMUTE . U� 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER SETBACK AREA. V 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIgENTIAL GARAGE/STORAGE ONLY. NOT TO BE USE FOR HUMAN HABITATION. Y ��-�b i -S Dk `��fS 6. \1 4�<� [� �_?1\7`� ^ -r, ' `T`.L.� SLa�Cr ��h ' `-' > o o c F '9 7. .,.1 � c. �..5 V �...- � I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0 ,2 _ 3 ?- P knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all y w m m �J -� information contained in this application(including any accompanying schedule)and I further declare that I recognize that this fD E. a to N ; a information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I °i a v .9 further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this 3 : rA: N '0 application. I agree to permit county officials charg administrating county ordinances or other authorized person to m = : o have access to the above-described p`r�e{mises ata reason�a a time for th ur s of inspection. p w U I c 1 OWNER'S SIGNATURE IS J` l ' m y g g v . p (date) BERM 0D c� ZONING ADMINISTRATOR 3 / 2O ^ : T'e.H a o m y a w O C7 TOWNSHIP PERMITS MAY BE REQUIRED MAR 17 2015 a M THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSU o BURNETT COUN (n N 6'f Yf fn " $ ZONING � � ��