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LAND USE PERMIT APPLICATION — Burnett County, WI e <br /> E: 1 <br /> cn Is) <br /> Applicant Complete All Sections Below This Line 0 <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 At <br /> JCommercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 '''--C <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> :.: <br /> ; <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 (— <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> • <br /> Filling/Grading $150 Boathouse $500 <br /> a <br /> Six Month Camping Unit(One Per Year) $100Permit Extension(1 Year Extension-Allowed Once) $100 <br /> _ v� <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: <br /> Lucas and McKenzie Kubista <br /> Property Owner's Mailing Address: 681258th Ave. N Crystal MN 55428 03 .. r, <br /> City State Zip ' eI_ (a <br /> Property Site Address:24252 Howe Rd.Webster WI 54893 1 R? <br /> Contact's Telephone Number:507-456-4414 c yrt <br /> p,f> <br /> 4, <br /> Contact's Email:Lucas.Kubista@gmail.com a <br /> Lot 2 CSM#3811V19P220 4- <br /> Legal Description of Property: pp <br /> N <br /> o bSection#:09 Town#:38 N Range#: 15W Town of:LaFollette <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> CI. <br /> Tax ID#(1-5 digit number;found on tax statement):9631 . <br /> Proposed Use of Structure/Addition: Home/Cabin <br /> Anticipated Start Date:06/01/2021 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C E <br /> Building Contractor:Woodlund Homes Sewer Installer:Hopkins Sand and Gravel 7 <br /> y p <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** <br /> %� <br /> OMDJG 2x651►J Stitj h+ct-k- QtI 5G}"b4 ( S <br /> Fee Rec:3'.r31 <br /> 8 Check#: 107) <br /> Date of staff site visit: /i1/2,I Initials of site visitstaff: . .� j1, L. �y <br /> APPROVED BY LAND SERVICES OFFICIAL: 4 / ' DATE: 14/7/d"/ o <br /> N <br /> UPON APPROVAL: APPLICA T ST POST COPY OF y a <br /> i ?„,- <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 <br /> N <br /> Transcendent: - Page 1 of 4 , 1 4 <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 i <br />