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LAND USE PERMIT APPLICATION — Burnett County, WI Cr <br /> Applicant Complete All Sections Below This Line a: 7 <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> a <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 C7 fi <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 -, 'J <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \ O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 4..1 FD <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> G1 Q� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °e }te r <br /> Filling/Grading $150 Boathouse $500o pq 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 .� <br /> En <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. P. <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. a" <br /> r 0 lk <br /> 0 <br /> Property Owner's Name: Ron&Kathy Derrick o <br /> m <br /> Property Owner's Mailing Address: 1462 112th Street New Richmond VVI 54017 $ IF <br /> City State Zip b k <br /> Property Site Address:6547 Devils Lake Road,Webster WI 54893 91 <br /> Contact's Telephone Number: Ron Derrick,612-599-4244 o c n <br /> a. <br /> Contact's Email: ron@derrickbuilt.com v <br /> d <br /> S <br /> Legal Description of Property: Government Lot 6 of Section 35 <br /> N "o <br /> Section#: 3s Town#: ao N Range#: 16 W Town of: Oakland ? °' <br /> o' <br /> 0' <br /> *Attach additional page if needed for lengthy description OR attach a copyofthe deed OR attach tax system property page.* <br /> d <br /> rA <br /> Tax ID#(1-5 digit number;found on tax statement): 13995 R' <br /> Proposed Use of Structure/Addition: Reconfigure interior space,add garage "' <br /> .- -3 <br /> Anticipated Start Date: 6-1-2021 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) �e <br /> v <br /> Building Contractor: Derrick Custom Homes LLC Sewer Installer: N/A <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: .A <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to 114 ` <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z (pi <br /> home additions,and bunkhouses.** x <br /> 11 <br /> glee-f 4 a.c sif <br /> ? c:. ilea( la(om OKycSd <br /> b 0.c.so✓ To 4-i 6 4121 <br /> 4.5 /no r2 + JO yew/ po4/44 `.Al <br /> a3 <br /> V z Fee Rec: <br /> K.K. Check#:501051 <br /> 1. r <br /> Date of staff site visit: 6 I/2- ' Initials of sj visit staff: v i �/ i <br /> 7.1 <br /> 0 <br /> /� DATE: 6/11/2-f rn <br /> < 0APPROVED BY LAND SERVICES OFFICIAL: / /' F <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a : <br /> 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT °' a hu <br /> o <br /> Transcendent: Page 1 of 4 m rc N <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 0 WO <br /> m <br /> 0 <br /> l_� D) <br />