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LAND USE PERMIT APPLICATION—Burnett County, WI OW g <br /> 9 - <br /> Permit Fees: S Y' <br /> Dwe ' " ci 1 Building-SinjOe Family $300 Addition to DwellinWPrinctrnl Building-Single Family $200 :� O <br /> Dwe ' rinci al Budding-Multi-Family $300 Addition to DwellingfPrincipal Building-Multi-Family $200 <br /> Commcrcial/Indwunal Building $300 Addition to Commcmial/Industrial Building S200 <br /> Amessory Swcture/Addition to Acc.Structure St511 Bunkhouse $250 <br /> Amcasory Struchue-Con m ial CI&Il $200 Addition to Accessory Structure-Commercial CI&11 5200 p 9- <br /> Deck/Staus/Patios S125 00 Gazebo Stat 59.692 1v 5350 <br /> C Unit 51Filling/Grading5150 <br /> Permit Extension(Valid for one year-Only 1 Allowed 5100 S <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. m <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. �• <br /> *items not listed above will be treated as accesso structures,such as:pergolas,landscaping,retaining walls. <br /> ro <br /> c <br /> Applicant Complete All Sections Below This Line s <br /> Z <br /> 0 <br /> Applicant's Name: John Hartley <br /> Applicant's Mailing Address: 12545 Danbury Way Rosemount MN 55068 <br /> City State zip <br /> z <br /> Applicant's Telephone Number: o " <br /> Applicant's Email:_johnh@jthlighting.com o <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ro <br /> []Letter []Phone X Email <br /> Legal Description: <br /> w <br /> Lot#: t CSM vol._10 Pg._87 OR 9 <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: 7 OR 1/4 1/4 9 <br /> Section#:_7 Town#:_40 N Range#:-15 W Town of Jackson t <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> Parcel#(24 digits):_07-012-2-40-15-07-5 05-007-012000 U Q <br /> 7 Cy <br /> Tax ID#(1-5 digits): 5112 <br /> Properly Site Address#: 28970 Nil <br /> Road Name: Sweger City:_Danbuuy <br /> Q <br /> TYPE OF PERMTT(S): Check appropriate box/boxes Fee Rec: ISo� <br /> 13 Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑Commercial Addition <br /> ❑Stairs X Acc.Structure(Non-bunkhouse) ❑ Bunkhouse ❑Commercial Aoc.Structure N � <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑Camping Unit ❑Commercial Acc.Addition Z <br /> " C <br /> Proposed Structure/Addition Use:_Garage-storage a SJ <br /> (HomelCabin;Commercial Busaesr Bedroom;Deck;etc.) Z m t1 it It <br /> oM 0Cs� <br /> Building Contractor: Northland Builders Inc K Z <br /> Anticipated Start Date: 9/2512015 Z 0 0 <br /> Page 1 of 4 o C <br /> Burnett County,WI Land Use Application — Rev 4/2015 > Z Ulf <br /> b <br />