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LAND USE PERMIT APPLICATION —Burnett County, WI b <br /> Applicant Complete All Sections Below This Line 0 c t <br /> CD 1 <br /> Permit Types and Fees(Please,check appropriate boxes) <br /> O <br /> Dwelling/Principal Structure $300 x Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °. 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 -- N <br /> 111 <br /> Filling/Grading $150 Boathouse $500 I <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. ' <br /> *Communication Towers,Camping Permits&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. c, ,,. Or' <br /> o ct <br /> Property Owner's Name:Cynthi1 Voelker o <br /> 0 <br /> n. <br /> Property Owner's Mailing Address: 9803 85th St S Cottage Grove MN 55016-3717 (-) ,� r‘- <br /> 2 City State Zip v, <br /> Property Site Address:/7849 Sand Lake Rd Webster WI 54893 <; <br /> g- <br /> Contact's Telephone Number:715-259-3257 ,_ _a. <br /> Contact's Email:northland001@centurytel.net <br /> N ° <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 = �' N <br /> @BurnettCountyWl.gov w <br /> Legal Description of Property:Lot 1 & OL 1 CSM 12/127 a ...—I -D <br /> Section#:25 Town#:40 N Range#: 15 W Town of:Jackson v <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> ....1 <br /> ° <br /> �� 1 <br /> Tax ID#(1-5 digit number;found on tax statement):5642 L.1 <br /> Proposed Use of Structure/Addition: porch ; <br /> Screen - rec room <br /> Anticipated Start Date:Feb 2023 _ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 0 <br /> N <br /> Building Contractor:Northland Builders Inc Sewer Installer: <br /> Z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY , <br /> THIS PERMITT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Q 2-C1 G i 54ar,9f `ntAl e-s/- y veto& of 9 96., Aft- /S /bp, ZOO tD <br /> lje— IS out ©� 7%e oc o>/gidl. �- <br /> r.2 pWe RC no+ -b €Y C.urci 14 ilfsirobrrIS 1 S A-N It 1�1!4F>' Fee iRec: cZ c�c7.0Lcx k and can n�CA-e,d an S,Q,/-l-c, 4-ailk )i d by 1`I 12t 2M ' Check#: 3 27 27 <br /> held m',f-; u <br /> 9�-f;�n --.__- -_`--J/ z r— <br /> Date of staff site visit: 2164 JZDZLI Initials of site vi it staff:� � <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: //z/22 'l Cc <br /> , C—i'CCD <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z o o p 1N11 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page l of S C CD <br /> Inal <br /> Burnett County, WI Land Use Application—Rev 12/2022 d <br />