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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> Applicant Complete All Sections Below This Line ' A <br /> Permit Types and Fees:(Please,check appropriate boxes) .� <br /> Dwelling/Principal Structure f$200 <br /> Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/industrial Structure Addition/Alteration to Commercial/Industrial Structure $200 <br /> Q O <br /> Accessory Structure(Garage,Shed,etc.) Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/SidewalkBunkhouse $250Driveways/&Campground Structures WI State Statute 59.692(ly)Structures $350Flliing/Grading Boathouse $500 <br /> Six Month Camping Unit(One Per Year) Permit Extension(l 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. ro <br /> *Items not listed above will be treated as accessorV structures,such as:pergolas,landscaping,etc. r <br /> 0 <br /> z <br /> Property Owner's Name: Timothy and Leslie Masterson ° <br /> 0 <br /> Property Owner's Mailing Address:_244- 12th Avenue N. ,Hopkins,MN 55343 <br /> n <br /> Property Site Address:27525 Thompson Bay Road,Webster,WI 54893 a <br /> Contact's Telephone Number:651-442-1638/612-490-3165 <br /> a <br /> Contact's Email:ticm@mccollumlaw.com C <br /> Legal Description of Property:Parcel located in Gov't Let 3(see attached) o e0 <br /> Section#: 36 Town#:40 N Range#: 15W Town of:Jackson <br /> t� <br /> *Attach additional page if needed for•lengthy description OR attach a copy of the deed OR attach tax system property page.* Et. <br /> Tax ID#(1-5 digit number;found on tax statement):6133 a <br /> Proposed Use of Structure/Addition: Home/Cabin o <br /> Anticipated Start Date:V10/09/2019 _ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C7 <br /> Building Contractor:�RPS Builders/Bob Streiff Sewer Installer: a C` <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: W <br /> Pew ho'61t wt u lot co wc4 co( -b teisfi' s�„�e.1! Rccc�cc� z <br /> vtwrr we use be semiceet io woro a l tce w 55. 333 61, � <br /> Fee Rec:?Jc-jy— <br /> Check 4: <br /> 5. <br /> Date of staff site visit: Initials of site visit staff: <br /> APPROVED BY LAND SERVICES OFFICIA .' DATE: !O M <br /> Q <br /> UPON APPROVAL: APAICA MUST POST COPY OF Q C, t�rtl <br /> z <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> 0 W <br /> CD - p <br /> CD,� 0 n �..! <br /> Transcendent: - Page I of 4 g w e �, o <br /> Laserfische: - _ Burnett County,WI Land Use Application—Rev 1/2019 2 Q <br /> 0 3 <br />