2011/04/19 - LAND USE - LUP - Other

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z Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administratorg C11 APPLICATION FOR LAND USE PERMITS 4- n G OWNSTELEPHONE a Pan�ur4 1'a' +� C� mmun " m£-r�� n/azananef o MAILING�,DD ... 1af . 5"76`3 D W �7Q�f.32 Perfir,�-. � >, h—� vvv111 PROPFP7vADDR LEGAL DESCRIPTION TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ BUNKHOUSE ❑ 59.692(IV)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ COMMERCIAL BUILDING COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ SZ c STRUCTURE/ADDITION USE: (J fy-� (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) C- BUILDING CONTRACTOR: TE'-!C� - (2. e,.S' >r L"Imo-nSe- -;Fr !!48357 c �W A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o y WILL BE RETURNED. c n DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) .r'i 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN 1'0 SCALE. T 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 9 I a AND INDICATE NORTH (N). `" N 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) EL ° TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK m O Pj (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. I O 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES TO BUILDINGS, ROADS, LAKE, LOT LINES. U u 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 \A o -Q- PLANS MUST BE SIGNED AND DATED BY THE OWNER. Iv J NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN .� Q NEEDED. /OICR7 S G THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I^1 F 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. a 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERiM:TTED. 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER NI SETBACK AREA. 1 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. NOT TO BE USED FOR HUMAN HABITATIOry - 6. fl6 0pprov'M v, de/C�rid hot) Perorf Iag3 0 7. 1S U W LGA ,fD A,U heeB SSary 1n5�'GhonS z ; ; g ° a o ro m -y a n h1 [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 Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this .o = D a m N Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I 2 a w < ^0 further accept all liability that may be a result of the County of Burnett relying on this Information I am provlding In thiso v,N . application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have a ;�, .� v o 1' access to the above-described premises at any reason le time for the purpose of Inspection. m w a o w N o o 5 > F) OWNER'S SIGNATURE �� / � (date) = a ti s9 g ZONING ADMINISTRATOR Tim Fla n,qy y g w N S n TOWNSHIP PERMITS MAY BE REQUIRED THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ck-ell �-,,p 6t) m a/Cr'.P- � J (Ll'l� � � S0000