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LAND USE PERMIT APPLICATION—Burnett County,WIcr <br /> 54 0 <br /> NCa Itej <br /> _ Applicant Complete All Sections Below This Line 5' <br /> co r <br /> Permit Types and Fees:(Please,check appropriate boxes) a. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 n <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200u) <br /> x <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 h.....) <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 "Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 5 <br /> Filling/Grading $1.50 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 S cn _I_ <br /> II <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. g. <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: Joseph Kvidera g- <br /> z <br /> 0 <br /> 11 <br /> Property Owner's Mailing Address: 5957 Pike Lake Rd Webster WI 54893 0 <br /> City State Zip 4. / , <br /> Property Site Address: Same o• n <br /> rn (164 <br /> Contact's Telephone Number: 651-605-5017 <br /> o <br /> r <br /> M. <br /> Contact's Email: joe.kvidera@gmail.com -0--,,, <br /> co <br /> Legal Description of Property: Lot 3 of CSM Volume 1 Government Lot 3 Section 25,Township 39 Range 16 <br /> Section#: 25 Town#:39 N Range#: 16 W Town of:Meenon S <br /> 5' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* CrQd <br /> Tax ID#(1-5 digit number;found on tax statement): ' <br /> Proposed Use of Structure/Addition: Shed/Storage <br /> Anticipated Start Date: 10/6/21 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Self/American Steel Sewer Installer:N/A t7 <br /> y <br /> 7. <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: .Q� <br /> (_ zzUJ <br /> Fleer <br /> . ._QiI.W�se�o rS (Ow 5f 1(eF ivk4 side 50+6tpI�) <br /> Fee Rec: <br /> Check#:171% <br /> aIPI13 <br /> Date of staff site visit: Initials of s' e visit s ff:1-L�/ <br /> /` - r.' <br /> 9 <br /> 1- <br /> APPROVED BY LAND SERVICES OFFICIAL: i DATE: 1/30142/ S <br /> UPON APPROVAL: APPLIC A MUST POST COPY OF a a fill <br /> v) <br /> m <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 ii m N lliro <br /> 1/ <br /> Transcendent: - Page 1 of 4 g y 0 -A <br /> Laserfische: Burnett County,WI Land Use Application—Rev 12/2020 k� Q <br /> d <br /> ifl�lU <br /> I LTJ <br />