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LAND USE PERMIT APPLICATION—Burnett County, WI a I ro
<br /> Applicant Complete All Sections Below This Line g' n'
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<br /> Permit Types and Fees(Please,check appropriate boxes) -lc' �-
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<br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 RI ro
<br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �. 9
<br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150
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<br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 `C 7
<br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o
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<br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ' S'
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<br /> Filling/Grading $150 Boathouse $500
<br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 '
<br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. b
<br /> *Communication Towers,Camping Permits&Signs require a different application form)see corresponding application,and fees. a
<br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. R.
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<br /> Property Owner's Name: Daniel&Ann Studnicka vim, lb
<br /> 8396 Portage Ln W Shakopee,MN 55379
<br /> Property Owner's Mailing Address: E.
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<br /> Property Site Address: 29251 Pine Knoll Lane C__ ll�anbnry, WI 54830 Zip �' C It
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<br /> Contact's Telephone Number: 952-7 6 (1-j‘,ffJ , 25 ;22--,l i' d.4/
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<br /> Contact's Email: dkstudnicka@ylahoo.com 0 '
<br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N -
<br /> legible and your email provider will accept emails from the following addresses:@BurnettCounty.org and 3 °O •
<br /> @BumettCountyWl.gov )/Kr.;y e, # L"19 ie ;Z/-c,Y u
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<br /> Legal Description of Property: /a.i,f),a 2,-, L P 9 it 2 , yl e.s�,�j. s J
<br /> Section#: of Town#: ilia' N Range#: il, W Town of: ��oil cA
<br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ' J 0 P ;
<br /> Tax ID#(1-5 digit number;found on tax statement): 19196 �� 0
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<br /> Proposed Use of Structure/Addition: ‘,..4j),.
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<br /> Anticipated Start Date: / i1'1 ` (Home/Cabin;Commercial Business;Bedroom;Deck;
<br /> etc..)
<br /> Building Contractor: (M fi 4i'u,,;, 4-v-dA eihei L.C Sewer Installer: V.;, , i -'1 j L% C
<br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z
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<br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW:
<br /> ()Meek-- e,l l 1ee,1ciri, A Ce, �io/13 O- %J -r;,/- 0'1 -
<br /> aYw e ccc S S N-a�? 3-l72D�,l� ,� � bed ef �
<br /> �P11 l �, iii;li5 '6nf ,� '
<br /> l �1 Y ��."h•O/I 0, Fee Rec: = Z
<br /> SItoteti'Ae Check#: + 5465
<br /> _J-,f{ t-rzv q.600
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<br /> Date of staff site visit: f/101/33 Initials of site,visit staff: fn1. kT ^"i;'
<br /> APPROVED BY LAND SERVICES OFFICIAL- 4,P,c DATE: t 11[12.3 3 r' COZ ` ,I;
<br /> UPON APPROVAL: APPLICANT MUST POST COPY OF : f �1.
<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w Erii
<br /> Page l of 5 _
<br /> Burnett County,WI Land Use Application—Rev 12/2022 = C=-_
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