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- z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE <br /> Donald Oblak 651-737-2598 �� <br /> / f <br /> MAILING ADDRESS v' <br /> 2347 14"AVE E North St Paul MN 55109 <br /> Li <br /> PROPERTY ADDRESS III •- � V <br /> 28409 County Rd C Is_ C7 <br /> LEGAL DESCRIPTION SESE Section 16 T40N R1SW IK2�1 <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING X ADDITION DECK GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE• 59.692(1V)GAZEBO STAIRS FILLING/GRADING CAMPING UNIT <br /> COMMERCIAL BUILDING COMMERCIAL ADDITION COMMERCIAL ACCESSORY STRUCTUREa <br /> r <br /> STRUCTURE/ADDITION USE: Home ° <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z <br /> 0 <br /> BUILDING CONTRACTOR: Northland Builders Inc <br /> r; <br /> T U <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. S o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, _ <br /> AND INDICATE NORTH(N). r" " a <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) <br /> TO CENTERLINE OF ROAD,(C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK o <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. Q R. C'J <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES <br /> TO BUILDINGS,ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Ir <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. o. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN h <br /> NEEDED. y 1 <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: <br /> 1rf91 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. � d <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. z <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. O <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. R/ ' <br /> NOT TO BE USED FOR HUMAN HABITATION. 1 <br /> 7. � � RSSSCaFt= <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge <br /> and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information <br /> contained <br /> rov di n hi II be li red a(including any accompanying schedule)and I further declare that I recognize that this information I n > > ®ti Y <br /> am p ng pon by the County of Burnett Wisconsin in determining whether to issue a permit. I further accept all .� c v — _ <br /> liability that may be a result of the County of Burnett relying on this information I am providing in this application. I agree toin" <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- <br /> described premises at any reasonable time for the purpose of inspection. <br /> ��W <br /> OWNER'S SIGNATURE <br /> (date) � <br /> Jim ��aniq�rl " a <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED (� f <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ^N " <br />