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LAND USE PERMIT APPLICATION — Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please, check appropriate boxes) <br />X <br />Dwelling/Principal Structure <br />$300 <br />Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure <br />$300 <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) <br />$150 <br />Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) <br />$200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Bunkhouse <br />$250 <br />WI State Statute S9.692(1v) Structures <br />$350 <br />Driveways/ & Campground Structures <br />$125 <br />Filling/Grading <br />$150 <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$100 <br />Permit Extension (1 Year Extension - Allowed Once) <br />$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 />Property Owner's Name: Dr Brad and Deborah Gustafson <br />Property Owner's Mailing Address: 11770 47th Circle NE St Michael MN 55376 <br />City State Zip <br />Property Site Addres&�-z�, <br />Contact's Telephone Number: Please contact 4orthland builders in with questions 715-259-3257 <br />Contact's Email: Please contact Northland Builders Inc northland001 @centurytel.net <br />Legal Description of Property: Lot 3 &1/7 INT in OL 1 - 4 Camp Daniel <br />Section #: 18 Town #: 40 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. <br />Tax ID # (1-5 digit number; found on tax statement): 6228 <br />Proposed Use of Structure/Addition: Home <br />Anticipated Start Date: ASAP (Home/Cabin: Commercial Business: Bedroom: Deck. etc.) <br />Building Contractor: Northland Builders Inc Sewer Installer: Hopkins Sand and Gravel <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />PLEASE SEND ALL CORRESPONDENCE TO I <br />Northland Builders INC �- 3 JymM se y~ <br />28520 Kilkare Rd <br />Danbury WI 54830 'j bejVbow, 1no.+4 e-,, <br />Ct <br />715-259-3257 <br />northland001 @centurytel.net <br />Date of staff site visit: qla1 Initials of site visit staff: I <br />I 1 z— <br />APPROVED BY LAND SERVICES OFFICIAL: 12 <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: - Page I of 4 <br />Laserfische: - Burnett County, WI Land Use Application — Rev 1/2019 <br />Fee Rec: <br />Check #: <br />m <br />a <br />ma <br />Q3 <br />v o <br />y j <br />�' o <br />oC= CVC <br />3 <br />m <br />c,o <br />