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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Check appropriate box boxes) c7 <br /> Dwelling/Principal Building-Single Family $300 Addition to DAelling/Principal Building-Single Family $200 rn <br /> Dwelling/Principal Building-Multi-Family 5300 Structural Alteration to Dmiling/Principal Buildings $200 O <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) 5150 Addition to Accessory Structure $150 <br /> 1 <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 < <br /> Accessory Structure-Commercial(CI &It) $200 I Addition to Accessory Structure-Commercial(Cl &I I) $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(l v)) 5350 <br /> Campground Structures 5125 Filling(Grading $150 <br /> Camping Unit(Six Months Per Year) $100 Boathouse 5500 y <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 /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. _ <br /> y <br /> Property Owner's Name: Patrick and Catherine Peick <br /> o h � <br /> Property Owner's Mailing Address:_811 Park Place Dr Mendota Heights MN_55118 g <br /> City State ZipC <br /> Property Site Address: 29225 County Rd H <br /> 1 <br /> Contact's Telephone Number: o t <br /> Contact's Email:_pjpeick@mmm.com b <br /> PP <br /> 3. <br /> Legal Description of Property:—Lot 3 CSM V25 P267 <br /> Section#:-28—Town#:_40_N Range#:_14 W Town of,.—Scott <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.' , d <br /> Tax ID#(1-5 digit number;found on tax statement): 34280 y 1 <br /> Proposed Use of Structure/Addition:_Garage lJ� <br /> Anticipated Start Date: 8/5/2017 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor:–Northland Builders Inc Sewer Installer:—NA (n z <br /> z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Fee Rec: QO(7 <br /> y <br /> to <br /> s <br /> H � D <br /> Date of staff site visit: Initials of site visit staff 45N M ❑c I <br /> 0 <br /> Z -1 t, i <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: I-5 Ct <br /> G) <br /> z <br /> Page 1 of 3 c <br /> Burnett County, WI Land Use Application—Rev 03/2017 <br />