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LAND USE PERMIT APPLICATION — Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br />X Accessory Structure (Garage, Shed, etc.) $150 Addition/Alteration to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(ly) Structures $350 <br />Filling/Grading $150 Boathouse $500 <br />Six Month Camping Unit (One Per Year) $100 Permit Extension (1 Year Extension - Allowed Once) $100 <br />*NOTE: After -the -fact permits (permit aquired after construction has begun) may cost 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 />Property Owner's Name: Thomas Denman Trust <br />Property Owner's Mailing .Address: 3675 Jeffers Parkway NW Prior Lake MN 55372 <br />3� `� <br />Property Site Address: '- V yc'3 City State Zip <br />Contact's Telephone Number: 715-259-3257 (Northalnd Builders INC) <br />Contact's Email: northland001 @centurytel.net <br />Legal Description of Property: That part Gov Lot 7 Desc 504-520 <br />Section #: 11 Town #: 40 N Range 4: 15 W Town of: Jackson <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br />Tax ID # (1-5 digit number: found on tax statement): 5223 <br />Proposed Use of Structure,'Addition: Storage Building — <br />Anticipated Start Date: 10/1/2018 (Home Cabin: Commercial Business: Bedroom: Deck: etc.) <br />Building Contractor: Northland Builders Inc Sewer Installer: NA <br />AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Nco 1 v rr,b,% Y7 C )�►v'�v� � �Q va � -r�-rs 6,1 1oW� <br />Date of staff site visit: 9 _ I Initials of site visit staff:414e�__ 9 <br />S <br />PERMIT APPROVED BY ZONING OFFICIAL: DATE: <br />UPON APPROVAL: APPLICANT UST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Page 1 of 4 <br />Burnett County, WI Land Use Application — Rev 1/2018 <br />NEW <br />D <br />9: <br />k <br />I� <br />g, <br />J <br />9 <br />V) <br />ei <br />9 <br />U1 <br />P <br />w <br />ee Rec:'3dy $ F <br />NI S O <br />Z C� <br />Cn <br />C= <br />x � <br />rV <br />O <br />