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O O <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS N <br /> p <br /> OWNER Don and Linda Hendrickson TELEPHONE 651-426-3319 o <br /> e <br /> MAILING ADDRESS 8835-126 St N Hugo MN 55038 <br /> i R <br /> PROPERTY ADDRESS 5571 Mail Rd 1 <br /> LEGAL DESCRIPTION Lot 2 CSM V 7 pg 146 Gov Lot 3 T40N R15W section 7 5•' <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING❑ ADDITION❑ DECK❑ GARAGE/ACCESSORY STRUCTURE I v, <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO❑ STAIRS❑ FILLING/GRADING❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ S' <br /> STRUCTURE/ADDITION USE: Game c ' <br /> (Home/Cabin;Commercial Business:Bedroom: Deck:etc.) <br /> BUILDING CONTRACTOR: Northland Builders Inc <br /> n <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/1 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o a <br /> WILL BE RETURNED. <br /> iu <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) IfI�`1 a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c d <br /> m y B n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW <br /> BUILDINGS/STRUCfURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH(N). Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) o P <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENTS)TO THE ORDINARY HIGH WATER MARK y <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. p <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRATNFIELD(DF),AND ALL DISTANCES <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. g• �, A) <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE c <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN �� J <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: �. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. >i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z 7 Cf <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. p <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. E <br /> 7. s 0 0 0p c b <br /> I dehiare that this application(Including any accompanying schedule)has been examined by me and to the beg of my knowledge ria .. <br /> and belief k is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information . A.tis <br /> contained in this applkatlon(including any accompanying schedule)and I further declare that I recognize that this information I > c 9 c m N; Y <br /> am providing will be relied upon by the Countf of aumett Wisconsin in determining whether to issue a permiL I further accept all 5 , a&v � 4 <br /> ing <br /> liability that may be a result of the County of Burnett relyon this information I am providing in this application. I agree to c 0 b <br /> permit county officials charged with administrating counfy,ordinances or other authorized person to have access to the above- '0 n.Z g o <br /> described premises at any reasonable time for Me gpurpwe i /+ 7 / C0 yh g 8 0 8 8 y <br /> OWNER'S SIGNATURE � W i iGGC "� / 4(✓ �/+-� � ���� [may >a_ <br /> (�� 6 n'to n Vl 'rl yO <br /> (dale) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED a <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ti s n s <br />