2010/10/15 - LAND USE - LUP - Other

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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g P APPLICATION FOR LAND USE PERMITS N N OWNER � rr,, (,JI 1 C �L2bD1 '5 5 1\rCI 444 O MAILING ADDRESS ,I 94 ,3E `� t S C`/ ,C, Com' A 4,3 E PROPERTY ADDRESS /)t(,_k S free f- '�T) LEGAL DESCRIPTION TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ m BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ O= O COMMERCIAL BUILDING ❑ COMMERCIAL Aq DITION ❑ COMMERCIAL ACCESSORY StiRUCTURE ❑ �`° I^ �J Ar STRUCTURE/ADDITION USE: rC�e�Vi (H m1 ne/ in;[Commercial usiinless; edroo ; Deck, etc.) C BUILDINGCONTRA OR: r` Jd � �'l Iry t0 70 - N A PLOT PLAN MUST BE PRO DE ON AN 'k X11 SWEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o _ WILL BE RETURNED. �n DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) o 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 m w o BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 0 v AND INDICATE NORTH (N). v N Y 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDING(S) g P TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARKw5 (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 4 TO BUILDINGS, ROADS, LAKE, LOT LINES. l 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 �O PLANS MUST BE SIGNED AND DATED BY THE OWNER. T Cp? NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ...� l NEEDED. j I THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: pp 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. y 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. OCs (� 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. d NOT TO BE USED FOR HUMAN HABITATION. 6. 7, ^ � > > o �o A R R 3 3 3 A I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 0 R e knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all d F- d ! :3 Information contained In this application(Including any accompanying schedule)and I further declare that 1 recognize that this .= 3. > > Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I .`= n y ! ,a 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 access to the above-described premises at any reasonable time for the purpose of inspection. m i ,A( ( c 'a m cop000 `3 OWNER'S SIGNATURE /� \. SLBr 3� hila O - nv > � mn v, m0 w m v Z (date) 0 �` a3' c �, n ZONING ADMINISTRATOR \) IIn k ian Fn o TOWNSHIP PERMITS MAY BE REQUIRED THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 0 0 0 0 0 ��/YYb {� � �-�-�'PX ✓�'1G1,a�P� ��1�