2009/06/19 - LAND USE - LUP - Other

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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator APPLICATION FOR LAND USE PERMITS OWNER ICK S C�E�I MoSF�ITIIJE TELEPHONEo. J -71S- ln5lo'7o)I o • MAILING ADDRESS lo-." L ( LW LANE DAM&k_zV k1r JSL/8 ?)o JC°I �7 ' PROPERTY ADDRESS LIST S S £ /LK4fLE G � 7�dADTTI a.I LEGAL DESCRIPTION SVC-rI0rQ Z T i jo N 7- 0_ { TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING P9, ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE 0 BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING❑ CAMPING UNIT❑ I COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION❑ COMMERCIIAL ACCESSORY STRUCTURE ❑ STRUCTURE/ADDITION USE: �- S22 �" IQ.y� c (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) pBUILDING CONTRACTOR:—RICIL L Da{7J Z I se 0 4 c,c . A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS _-) 0 � WILL BE RETURNED. itv DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) o 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. o, 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEWO BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, OSJ F AND INDICATE NORTH (N). N Z 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B)BUILDING(S) (),) o O TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 2 (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. p X43 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD (OF),AND ALL DISTANCES J TO BUILDINGS, ROADS,LAKE, LOT LINES. S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. K3 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE I o (I) PLANS MUST BE SIGNED AND DATED BY THE OWNER. p, NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN NEEDED. r c p THIS PERMIT IS SUa3ECT TO ALL CONDITIONS LISTED BELOW: r IC ^ S 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1Z CKII 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER f tt SETBACK AREA. " S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. NOT TO BE USED FOR HUMAN HABITATION. 6. 7. ; a e e e a ro it ' 333 8:M L` 7.' onoSo� S !dedare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge and belief it is true,coned and complete. I acknowledge that I am responsible for the detail and accuracy of all g ' m Edda: y Information contained in this application(including any accompanying schedule)and I further declare that I recognize that this �" 5.a infornation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I is: n ,`d'w= .y further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this �'^" p ty v ty yg v d o ^ y : Nr IV application. I agree to permit county oHidals charged with administrating county ordinances or other authorized person to have access to the above-described premi�ses/at any reasonable time for the u se of inspection. m o w N W> OWNER'S SIGNATURE gran W M O a.yy� TJn a .YE. ''t�r ZONING ADMINISTRATOR E g8 : _ TOWNSHIP PERMITS MAY BE REQUIRED THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N N O O p O O �e✓ml�� I��-J�r��cK�c� up �/ 2�Ck,�� lhr�s��a "�'9