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z <br /> Burnett County 7410 County Road K,No.102, Siren,VYI 54872 Office of <br /> Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER David and Debra Dziuk TELEPHONE a <br /> MAILING ADDRESS 13470 49th Street N Stillwater, MN 55082 <br /> I\ ; <br /> PROPERTY ADDRESS 27927 Sand Lake Rd 0 a <br /> a <br /> r n <br /> c a <br /> LEGAL DESCRIPTION c>. <br /> SINGLE FAMILY DWELLING❑ GARAGE/ACCESSORY STRUCTURE X ADDITION❑ STAIRS❑ <br /> TYPE OF PERMTr(S): <br /> FILLING/GRADING 0 CAMPING UNIT 0 BUNKHOUSE T_l 59.692(1V)GAZEBO 0 DECK❑ c <br /> Garage/Storage Only B <br /> STRUCTURE/ADDITION USE: z i <br /> 0 <br /> (Home/Cabin;Commercial Bugne55;Bedroom;cede;etc) <br /> BUILDING CONTRACTOR: <br /> R & R Construction 3 l-i 8 a6 Cake ied <br /> Cj <br /> as�i`7cqg3 X33-0/ 3� N <br /> A PLOT PLAN MUST BE PROVIDED ON AN S 112 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS = w <br /> WILL BE RETURNED. <br /> CC <br /> DIRECTIONS FOR PLOT PLAN DRAWING (ARLlL OR TOP VIEW) �_ b <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n Iy A <br /> 2. SHOW THE LOCATION AND SEE OF ALL EXISTING BUILDINGS/STRLICTURES(EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS) <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(g)TO THE ORDINARY HIGH WATER MARK w i <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(TO AND DRAINFIELD(DF),AND ALL DISTANCES <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. I N <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ..I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ErC.,THE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> p <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN -i o <br /> NEEDED. m O <br /> o <br /> THIS PERMIT IS SUBTECT 7q ALL CONDI'fION5 LISTED BELOW. � q <br /> w <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. '" x <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA, <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. <br /> tA <br /> I declare that this application(including any arcampanying schedule)hm been ermined me and m the best of S n R is`::e <br /> by my knowledge 9 9 • ° g <br /> and belief K 15 true,correct and complete. f admowledge that I am responsible for the dared and accuracy or a8 information 3 o K w � ; Fro <br /> contained in this application(Including anyaccampanying schedule)and I farther declare that I recognize that this Information I <br /> am providing will be retied upon by the OwMy of Burnett Wisconsin In determining whether to Imue a permit. I further accept all ^' ` <br /> liebility that may be a insult of the county or Burnet:mlying an this information lam providing in this appgcation. I agree to permit 8 <br /> wuMy officials charged with adminisho ng county Ordlnabaea Or Other authOrimd peroon W have access to the aboy"escribed w o 4'v h7 <br /> premises at any reasonable for the purpose Of inspection. <br /> m LIw-4 <br /> OWNER'S SIGI 'l.r'0—1 Ey pli He <br /> (date) n ca: ,,.„ a"C-) <br /> ZONING ADMINISTRATOR -F._�h <br /> TOWNSHIP PERMITS MAY BE REQUIRED e ' <br /> HIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> Q� <br /> � <br /> ld oNNN <br /> m" <br /> i/T 09£SE99356 AOT 9-laulludg4TOaH XV 90:90 LOOZ-9T-400 <br />