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JUL-09-2012 11:43AM FROM-MAYO NE CLINIC 5075388543 T-286 P.002/002 F-113 <br /> N v Z <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS o <br /> n <br /> 6 <br /> OWNER TELEPHONE <br /> Jeffrey and Elizabeth BunCh <br /> MAILING ADDRESS <br /> 2323 67"St NW Rochester MN 55901 � I <br /> PROPERTY ADDRESS <br /> 4498 Rookery Rd Danbury WI o \ <br /> < nt <br /> LEGAL DESCRIPTION Lot4CSMV9PG6B (032-5226-07600orG7-032-2-41-15-26-505-003-032000) <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING U ADDITION O DECK U GARAGE/ACCESSORY STRUCTURE U Y\' <br /> BUNKHOUSE U 59.692(1V)GAZEBO U STAIRS U FILLING/GRADING❑ CAMPING UNIT O ?. <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION U COMMERCIAL ACCESSORY STRUCTURE O <br /> STRUCTURE/ADDIIIONUSE: Porch Ui✓ Or PY1ST/gyp r��j(L 8 Y.�lo 3- <br /> (Home/Cabin;Commercial Business;Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: Northland Builders Inc <br /> N <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 sh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS A <br /> WILL BE RETURNED. <br /> � o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) M ^ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGSISTRUCTURES(EB)AND ALL NEW C I <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) c <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK G <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. rn d <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES 1 G su <br /> TO BUILDINGS,ROADS,LAKE, LOT LINES. sij <br /> S. 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,LTC.,THE ,. <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. y7t, a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN R3) 1 Q <br /> NEEDED. -t <br /> THIS PERMIT IS SUIMECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 7) <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. n <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER a <br /> C7 <br /> SETBACK AREA. (J,1 r U� <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. Rl <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7y > nr)nC > a ^ <br /> 7. <br /> gn ^ 333 "- Z <br /> I declare that this apPllcation(including any accompanying schedule)has been examined by me and to the castor my knowledge 3 <br /> and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information $ m=F w <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this information I dn D Da <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit I furtheraccept all .< - ^n a E <br /> liability that may be a result of the County of Burnett relying on this information I am providing in this application. I agree to <br /> permit county ofRclats charged with administrating county ordinances mother authorized person to have access to the above- <br /> described premises at any reasonable time for the purpose of inspection. ^m g 5 y a <br /> I El > 8go88 ? <br /> c <br /> OWNER'S SIGNATURE I'In�`/n1` vI m H m <br /> (da ) s �' Ra <br /> � �. IT <br /> ZONING ADMINISTRATOR %A;;;;Z 5. <br /> P <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> re <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />