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t LAND USE PERMIT APPLICATION—Burnett County, WI g <br /> w <br /> Applicant Complete All Sections Below This Line p' 4 <br /> Permit Types and Fees:(Check appropriate box boxes) G <br /> DwellingJPrincipal Building-Single Family $300 I Addition to Dwelling(Principal Building-Single Family $200 1 9 <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling(Principal Buildings $200 !� O <br /> Commercial/Industrial Building 5300 Addition to CommerciaVlndustrial Building $200 <br /> Accessory Struct ure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 1 ~ <br /> Bunkhouse 5250 Structural Alteration to Accessory Structure $150 <- <br /> Accessory Structure-Commercial(Cl &11) $200 Addition to Accessory Structure-Commercial(Cl &I I) $200 pr <br /> Deck/Stairs/Patio/Retaining WaIVSidewalk/Driveway& Gazebo(WI Stat 59.692(l v)) $3.50 y <br /> Campground Structures $125 Filling/Crading $150 <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 <br /> rn <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 S <br /> z <br /> *NOTE After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. <br /> "Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *hems not fisted above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> lt�Property Owner's Name:—Karen and Craig Amundsen <br /> Property Owner's Mailing Address: 5984 Royal Oaks Dr Shoreview MN 55126 _ a <br /> City State Zip o t <br /> Property Site Address: 27866 Leef Rd <br /> Contact's Telephone Number:( L�Qj 46V t <br /> Contact's Email:_amundI85@umn.edu o 7 <br /> N v1 1 <br /> Legal Description of Property: Lot 1 CSM V14 P159 sgt' <br /> Section#:_26 Town#:_40 N Range#:_15 W Town of.—Jackson <br /> 'Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page. I <br /> Tax ID#(1-5 digit number;found on tax statement):-5702 •� 1 <br /> Proposed Use of Structure/Addition:_Addition/Office and Garage <br /> Anticipated Start Date: 9/1/2017 (Name/Cabin;Commercial Business;Bedroom;Deck;etc.) I <br /> Building Contractor—Northland Builders Inc Sewer Installer:—NA z <br /> z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: V I <br /> Fee Ri <br /> H <br /> N <br /> 6 <br /> rn <br /> N <br /> C <br /> Date of staff site visit: In' 'ais of site visit staff: Z <br /> I i M <br /> Ec' <br /> PERMIT APPROVED BY ZONING OFFICIAL: DAT `L S– 17 1� o <br /> 40 o �, <br /> Page 1 of 3 �z <br /> Burnett County, WI Land Use Application—Rev 03/2017 <br />