2010/04/05 - LAND USE - LUP - Other

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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g APPLICATION FOR LAND USE PERMITS ,. OWNER / i a+h leen / In� /_ o�_� TELEPHONE o O MAILING ADDRESS CC L r'! yJ I \- a�a5 G�OIe I/a ��eU ✓� wy�d�h✓ � r0 '-- PROPERTY ADDRESS QC/ / „GL/L e re-GYj r V L � n LEGAL DESCRIPTION 1=. TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ {rn BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING O CAMPING UNIT ❑ �d 2 r COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑, COMMERCIAL ACCESSORY STRUCTURE C10 J� STRUCTURE/ADDITION USE: / I o I l/y,e' -LJC(,i�QDIY� o (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) n BUILDING CONTRACTOR: � � Q O A PLOT PLAN MUST BE PROVIDED ON AN 8 '/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS p o WILL BE RETURNED. (' DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) "\ 001 1 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C 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, _ 5 AND INDICATE NORTH (N). 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 3, w p (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. m S. 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 PLANS MUST BE SIGNED AND DATED BY THE OWNER. D NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN y NEEDED. r THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: O 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z G 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER C SETBACK AREA. I 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. NOT TO BE USED FOR HUMAN HABITATION. 6. Q 7. 7ya �� nnae I declare that this application(including any accompanying schedule)has been examined by me and to thebest of my 3 0,°2 " g m knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m d d v rn Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this o c_a 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 .� "g a w 7 ''V further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this o H d+'^ application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have f0 d,°z S"' g 8 r access to the above-described p e at y reaso a tl for[he purpose of Inspection. cad ap «,A�o f1 �� A y °. 00QOO > OWNER'S SIGNATURE Ree -a O a6w�9r.� 3, 0 _ (date) STRATOR �'r r/✓ katZONING ADMINI TOWNSHIP PERMITS MAY BE REQUIRED O '° THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE — }e� P1ckepl>✓ p&ICafhlPen LtOdl)O-) � � 0000g