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LAND USE PERMIT APPLICATION —Burnett County, WI cr 0 <br /> cia <br /> Applicant Complete All Sections Below This Line ° t� <br /> Permit Types and Fees:(Please,check appropriate boxes) d I . <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 N- O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0_ <br /> , t <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 cia C <br /> Permit Extension(1 Year Extension-Allowed Once) $100 <br /> 5 <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. r- g. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> r1 <br /> KAREY& DAN STRANDQUIST <br /> Property Owner's Name: 0 - <br /> Property Owner's Mailing Address: 1868 IOWA AVE E ST PAUL MN 55119 z <br /> 28946 BOBCAT LN CitYNBURY State Zip I" e <br /> Property Site Address: DAWI 54830 am.... a <br /> 651-894 -3637 Ii <br /> Contact's Telephone Number: a <br /> 7, <br /> danstrandquist@gmail.com %-/Y <br /> Contact's Email: N <br /> Oa <br /> Legal Description of Property: LOT 1 CSN V 2 P 88 (IN GOV LOT 8) <br /> 0 <br /> Section#: 07 Town#: 40N N Range#: 15 W Town of: JACKSON <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* tn <br /> Tax ID#(1-5 digit number; found on tax statement): 5115 0 H H <br /> Proposed Use of Structure/Addition: NEW SHINGLED ROOF t7 <br /> Anticipated Start Date: 4/1 1/2022 ? (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) H A <br /> 0.1 <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> III, V ' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions,and bunkhouses.* <br /> QMee at Sc-ha <br /> gNo <br /> 5;1W s tree( nceol5 6046 64 Qer -1' 4 I" ID reek 5‘4644-15 0 6// , <br /> Date of staff site visit: Initials of s'te visit toff: a <br /> 31112-� Fee Rec... ---- <br /> _ 77 o Check#: 1 G31-1 _ <br /> - <br /> 3/e/2- <br /> APPROVED BY LAND SERVICES OFFICIAL: / DATE: a <br /> UPON APPROVAL: APPLICANT '. ST POST COPY OF J <br /> iffl <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT : 0 CD rri (5 <br /> , m3 w <br /> Page1of5 ', m = ...... <br /> (� <br /> Burnett County, WI Land Use Application—Rev 12/2021 < m 2 R, e <br /> mea Ca V <br /> cn cn a� hJ <br /> Qt. <br />