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LAND USE PERMIT APPLICATION—Burnett County, WI Q b <br /> Applicant Complete All Sections Below This Line <br /> A C <br /> Permit Types and Fees:(Please,check appropriate boxes) 0 <br /> X Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 N <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 G <br /> F <br /> Accessory Structure(Garage,Shed,etc.) $150 X Addition/Alteration to Accessory Structure $150 <br /> n <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 �Y <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 i-- <br /> 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 1 Permit Extension(1 Year Extension-Allowed Once) $100 <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 /> z <br /> Property Owner's Name: Scott Robinson ° <br /> 0 <br /> Property Owner's Mailing Address: 3343 Pioneer Place Stillwater Mn 55082 <br /> City State Zipp <br /> Property Site Address:24702 Fosmo Drive Webster WI 54893 <br /> o v <br /> Contact's Telephone Number:651-261-0578 0 <br /> SR3343@gmaii.com - -4 <br /> Contact's Email: @9 � ��� - � t� �2 i� "` <br /> Legal Description of Property:Part of Gov. Lot 3 Sec 4 T 38 N R 15W <br /> Section#:4 Town#:38 N Range#: 15 W 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 /> Tax ID#(1-5 digit number;found on tax statement):9263 <br /> Proposed Use of Structure/Addition: <br /> Seasonal <br /> Anticipated Start Date:September (Home/Cabin:Commercial Business;Bedroom;Deck;etc.) C7 <br /> Building contractor: Burch Enterprise, LLC Sewer Installer: Dan Burch (Reconnect) <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> -fit Sx 1644 Sh.GC( Io� wnctt-r -fo be W4Ve 4-o meek !! seflosas. <br /> UDC ►speCtor Will be r u��eo( fo ,^ev; l�s dwej«'viG. <br /> d � <br /> Fee Rec: U <br /> Check#: Lri <br /> U_ <br /> Date of staff site visit: /CQ ;Lal� _ Initials of site visit staff: <br /> APPROVED BY LAND SERVICES OFFICIA ATE: 1 <br /> UPON APPROVAL: APPL CAN UST POST e4Y OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 <br /> N <br /> vo <br /> Transcendent: - Page 1 of 4 0 a C <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 K �' <br /> C <br /> w <br /> a <br />