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Home My WebLink About25-0225117 E 5m Street, PO Box Bayfield County Planning and Zoning Department Washburn, WI 54891 LAND USE PERMIT APPLICATION permits(&bayfieldcounty.wi.gove.c,r st-tr-t-f Apo / ,! • County Use On Submission#________— 16A Permit #: Date: 5/J25 SECTION At General drtu ooE 4': 4. Property Owner Name: Authorized Agent Name (if applicable): NAMA KNB Todd Dejno Telephone Number. Telephone Number. 414-217-1199 414-217-1199 E -Mail Address: E -Mail Address: ejnotodd@gmail.com ejnotodd@gmail.com Mailing Address: Mailing Address: 13225 W Honey Ln 13225 W Honey Ln City, State, Zip: City, State, Zip: New Berlin WI 53151 New Berlin WI 53151 Contractor. Telephone Number. E -Mail Address: J&H Premier Concrete 715.607.1214 [hpremierconcrete@gmail.00m SECTION B',Pro ` Tniormidiou a �a',r, Project Address (if different from mailing address): 6395 CO HWY D Cable WI 54821 Legal Description (if additional space is needed attach a separate sheet): Lot 2 CSM #2199 in V.12 P.429 (Located in govt lots 3&4) tog with ease in doe 2022R593299 Section, Township, Range: S35 T44N R06W Town of: Grand View Tax ID #: 38642 Lot Size (Acres/Square Feel): 11310.. SEC ION:C: Projee7lnlarmiiiioa• efiecle®LLiha1 Project Use is: O Residential ❑ Commercial O Municipal Project Type is: O New Construction O Addition/Alteration (existing structure) ❑ Change Use (existing structure) O Relocate (existing structure) O RV Placement 21+ days ❑ Sign O Establishing a Business O Temporary (12 or less months) ❑ Shoreland Grading, Class A O RV Placement 4+ months, Class A 0 Other (describe): required (Total sq It): aired tmrmnaae n.mwm.r. SECITON:D StyueLliiTor>mdian ` ;fn RVs'and' "to Section ,t " - i1c4 Structure Type is: ❑ Residence O Principal Structure (describe): ❑ Accessory Structure (describe): O Shoreland Exempt Structure (describe): O Mobile Home (provide manufactured date): ❑ Shipping Container O Other (describe): Foundation Type: ❑ Basement EI Walkout Basement O Slab O Crawlspace ❑ Ground O Skids ❑ Other (explain): Existing Structure: Length:"' Width:a.n Hei Proposed Structure (Provide Sq Ft based on outside dimensions, including unfinished areas, attachedgarageslabovegrade decks/porches): Basement Sq Ft 1" Floor Sq Ft Loft Sq Ft: 2°°Floor Sq Ft: 3" Floor Sq Fl: Garage Sq Ft Pomh Sq Ft: Deck Sq Ft: Other Sq Ft (describe): Other Sq Ft (describe): new mrcM. o+b a mri.ame Total Sq Ft aooe Overall Height (finished grade to peak): on grade # of Stories: Existing # of Bedrooms on property:4 Proposed # of Bedrooms in project NA SECIiON & R : ai% SC"iluforiaii%"a RVis: Sign is: ❑ New ❑ Replacement O New O Replacement ❑ On -premise O Off -premise ❑ 1 -sided ❑ 2 -sided Year. Vin#: D On -building O Multi -Tenant Lend: Widtit: Height: Make: Model: Scanned with CamScanner HE G �V n APR 222075 .. SECTION tic Plan —attach a site plan or draw site plan in box below (Sec pages 1 & 2 of Land Use Pent Application Information for information tint is re uimd to be providal on site plan) Show location of: ❑ Drive ays 0 Frontage Roads (include name) ❑ Existing Structures ❑ Well (W) O Septic Tank (Si) ❑ Drain Field (DF) ❑ Holding Tank (H1) 0 Privy (P) ❑ Lake ❑ River ❑Strcam/Creck ❑Pool ❑Flood Lin ❑Wetlands DSlos aver 20'/o N 4 Jr•vcw.7 Lot' tint - 49' 3r ----s-c; Setback ordis(ance from furthest eztentofstructure G including eaves and overhangs to (include on site plan): VI Road Centerline ft Front Lot Lire/Riehtof-Wav ft --Ifs Use Only Side Lot Lire 1 (N710 orth❑EastDSontbO Westf, check one ft ft Side Lot Line 2 (Nor1h9EastDSonthDWestfl, deck ore ft 1t 710 Rear Lot Line ft (� It Septic/llolding Tank ft V ft Drainfield ft r/ ft I rimy ft n well ft (; ft ECislinv Stmtrirreif,ril,linn ft_ ft r Wetla� ft flelation of Floodpiain ft fL Ordinary High -Water Mark (OHWM) I IL I IL Otter (describe) [t IL 2 • See fllan r Pero..r aloe erfr i") %/a {;o f1Lait W/7( Mrt, GOy6/, f'e Scanned with CamScanner i 2021R-591063 eaia J. I$FC GIFIEID a ct. 1R BAYFIELD COUNTY 09/22/2D21 f6:15:+1 CERTIFIED SURVEY MAP NO. pggI FI` `c°y' LGDIIG FEE: 30.00 ,- AD.-VWRTONOF LOT It PAOf LOT2OFCSM9165RECORTHE BAYFELD PAGES: 2 i COUNTY REGSTRT AS DOC.4311171 INVTJL 2OF CSWS ONPG5211.211A1 CSM LSS77 L) �I • ita RECORDED wmlw THE BATFIEtD COIOITY %tEGXM AS DOG nItVA IN VOLT OFcsl ON PO 214. LOCATED ONGOVTLOTS I/ A.SECT10N ATDMOO'Y I %I 1a '�I r 4-81W- ?1'l/ lun.•cJ�cvx�a•— i NORM RANGES OF GRJWOYaw. BATTE1D COUNTY. O - �_{4 .41flOI 111111, a4ir, src a rrwJv 1 r 1 ON rp r=mWrrA!wraro • rocunvro.rrt1 •-„�L. •5/'i'''. I / J� 4i ASHLN 2-_ •rA••rsaa amu>n � 3 �i 1Q;' pD\ 1 \\ "� /9. '�n�y yo �tL-e, R>ODLMri�M Y � � rlarca rotfAfsnnr.. y,�M(s�' ' +/ a��'�tMtrJAA•M rat '1�\\ LINE TABLE `�' � �rJJu aJ� � b w \ UNE SERiJGI 0ISTAJCE L3 S2313U3E I 1a' U S]5.1S134 351? u 9a9t1A3£ IssIs u IME 3377 LC IN LI 11113U Slit II n 4315":av /b/ raf ' 40 LDTr; •s �\ l if o \ o vos•SE Je 3r 7T 7 4'! • ,4n-cE�'ra :. . AffroJowTE Atorw RUFAL•{E Drat. 3. -•— ]3rTt Y'A9GELO I't - LW1 hxt S VtLMP '{_ yesEcrTD Tls naucTRusT TSMTIS E5TAlU9mlMFA''H3� i yyS1'TRi L(sECTla toc nlE SArzI2I�+snRJf�L '• _ i- A LDctrlollK ,rOsruK '. s3T1•E AIOAAE raa PLrrJ3[r•cao•Lr.A rrarAN+a+ • - C,' • - - yIOCFtIh(AT1d Wl51Q AETIr �.ILLTTD 3C la- I- •1 iD. x IB- war+ PIPE • s LDS PER UN- root I. !IRCNPIPE \ h- '2 `ARMCL0cRDED AS A r• _ in i -EPTZC LID rr -aLCTalc PEDESTAL `� r I -SWAMP r tee. FULDAOwc •^McTcn'P*L. NID7 �. EJI'r4 CnrnF Rlc acnrc - sbcgnn LtF l5{mnc.R AS DE1MD nY BATS3IID CDULTV SlAJN1LON p ) ORdvANCE tats4-14 P] LCT2ir LOT 3- tap Pine Ridge lied Surveying. LLC. hufcuow LeA SIa.ef• SOvm ' r.J..a O-.J.,-La•T.AU— fA7AICC A. NCq:L%rLS IATA AgtYa. t ',L V* trL Oc fL y4mWn PIm• (715) aa2-29x9 N% LPINERIDGE$DRVEYRCCpy PROJECT NO. KUKUS I . y3 -Fad SHEET t OF 2 SHEETS -" .._........._... Scanned with CamScanner From: J & H PREMIER Concrete jhpremierconcrete@gmail.com Subject: Drawings Date: Mar 21, 2025 at 6:38:18 AM To: Todd Dejno dejnotodd@gmail.com Attached are the drawing for the stairs and patio. I [(EuWED 1111 APR 222025 Bayfleld Co. Zoning Dept. • o.sHle 'II 'UIiIIiiEiIII• iiiiiiiir :n;fuhhhmfh IEnamaa 1a11111111 iil :flIIII IaU I III!1111H011 C ' 1 ;FIn: mu •aaa.uaauiifl eeeoev'' e ae:::aeeeeae JK Scanned with CamScanner 'SZCflO1CC i►d O Yes ❑ No Has the location of the proposed project including eaves and overhangs and the sanitary ayalem,and. well ban . staked? V no what date will this be completed: O Yes 0 No Did a licensed surveyor mark lot line(s) if project is within 10 feet of required setback? See page 2 of Land Use Application Information for required setbacks. ❑ Yes O No Did property owner or applicant mark lot line(s) if project is within 30 feet of required setback? See page 2 of Land Use Application Information for required setbacks. O Yes ❑ No Is therean existing sanitarysystem on the property? If yes, what kind? O Drainfield ❑ Holding Tank ❑ Municipal/Public O Other (describe): ❑ Yes O No Will pressurized water be installed in the structure? If yes, what kind of sanitary system will be installed or used to manage wastewater? ❑ Drainfield ❑ Holding Tank O MunicipaliPublic 0 Other (describe): ❑ Yes El No Will sleeping occur in the structure? If yes, contact local Uniform Dwelling Code (UDC) for approval and inspection requirements. Is the project associated with any of the following: ❑ Rezone O Class A Special Use O Class B Special Use ❑ Conditional Use O Variance Fee payment will be made via: ❑ Check (attached) ❑ Cash (attached) ID debit/credil/echeck (department to call once payment is ready to be taken) How would you like to receive your permit card? O Mail to: OR O Email to: O Property Owner Address ❑ Agent Address O Contractor Address O Other (provide Name and Email or Address): Section H AelmowkA""— "mtaiiiC6 Y; All Land Use Permits expire Two (2) Years from the date of issuance if construction or use has not begun Sanitary Permit issuance, if required, needs to occur prior to Land Use Permit issuance. Failure to obtain a permit or starting construction without a permit will result in penalties. The local Town, Village, City, State or Federal agencies may also require permits. The new construction of one- & two-family dwellings requires review and approval by the local Uniform Dwelling Code (UDC) authority. Additions and alterations to one - and two-family dwellings may require review and approval by the UDC authority. All municipalities are required to enforce the UDC. If subject property is part of a Condominium Plat, applicant hereby certifies and represents that applicant has all necessary approvals and recorded documents required to complete the project for which this permit is sought including requirements set forth in Wisconsin statutes pertaining to condominium associations, the Declaration of the Condominium Association in which the property is located, and all other rules, regulations and requirements pertaining to that Condominium Association You are responsible for complying with state and federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification of construction that violates the law or other penalties or costs. For more information, visit the Departmentof Natural Resources wetlands identification web page, dnr.wi.eov/topic/wetlands. or contact a Department of Natural Resources service center(715)685-2900. I (we) declare that this application, including any accompanying information, has been examined by me (us) and to the best of my (our) knowledge and belief it is true, correct, and complete. I (we) acknowledge that I (we) am (are) responsible for the detail and accuracy of all information that I (we) are providing and that will be relied upon by Bayfield County in determining whether to issue a permit I (we) further accept liability which may be a result of Bayfield County relying on this information I (we) are providing in or with this application. I (we) consent to county officials charged with administering county ordinances to have access to the above -described property at any reasonable time for the purpose of inspection. Owner(s) or Authorized Agent Printed Name: Owner(s) or Authorized Agent Signatu Date: •� NOTES: 1. If you are signing on behalf of the owner(s) a letter of authorization must accompany this application. 2. Specific conditions/instructions maybe stated on the face of the issued Land Use Permits. Owners, agents, & contractors must all be aware of permit details & conditions and permit card must be posted on property prior to start of project Scanned with ® CamScanner'. 1111 APR 221025 Bayfield Co. Zoning Dept. AFFIDAVIT OF AUTHORITY (Corporation, LLC, etc.) PURPOSE. This Affidavit of Authority is used to certify the individual submitting an application is authorized when the property Is owned by a corporate/business entity. STATE OF WISCONSIN ) ss. BAYFIELD COUNTY The undersigned affirms and states as follows: 1. Address of Subject Property: 96315 Ca ft..s e L2 CQ6/-e Id) SYS,Z 2. The Subject Property is owned by: 444qux k n a (Name of Company) 3. The name(s) of the current President or Managing Member, 1r .. 4. I certify that the company named in paragraph 2 is valid and in effect on the date signed below. I am the duly appointed agent of the Company named above in paragraph 2. and I have the authority under the terms of said authorization to submit an application to the Bayfield County Zoning Department concerning the Property described in paragraph 1. I further certify that the Information and statements made within this affidavit are true, accurate, and complete to the best of my knowledge. 5. I am authorized by the above -named Company to apply for and bind the Company to the terms and conditions of any decision or permit issued by the Bayfield County Zoning Department. 6. By signing this affidavit, I attest that I am unaware of any known or unknown person(s) who would contest this application. I agree to indemnify Bayfield County or such person or legal entity suffering 2 a damage resulting from any illegalities of the application. Dated: ��' /J rlQZS 1�^Print Name Subscribed and sworn to before me this day of kk , 2016. rG0 RTlyy; , No aryPubli , County, Wisconsin AG "� My commission: ;\� Scanned with LM CamScanner Bayfield County Impervious Surface Calculations These calculations are REQUIRED per WI Admin Code NR 115.05(1)(e) and Section 13-1-32(g) and 13.1. 40(h) of the Bayfield County Code of Ordinances. The undersigned hereby makes application for construction, reconstruction, expansion, replacement or relocation of any impervious surface within 300 feet of the ordinary high water mark and agrees that all activities shall be In accordance with the requirements of the Bayfield County Code of Ordinances and all other applicable ordinances and the laws of the State of Wisconsin. Pursuant to Chapter 1, Title 13, Section 13.1-106(d) of the Bayfield County Zoning Ordinance(s), Planning and Zoning Department employees assigned to inspect properties shall have access to said properties to make Inspections. Property Owner(s): NAMA KNB Malting Address: Property Address 3225 W Honey In New Berlin, WI 53151 16395 CO HWY D Cable WI 54821 Legal Description: Secction, Township, Range lct z am 2t99ysytz Rtes 114, wth eeee h doc z0P2RSo3 a 114, Sec== Township Tow N, Range rmsw W Authorized Agent/Contractor : -1 Govt Lot I Lot # CSM# Vol & Page odd Dejno &4 2199 Lots) # Block(s) # Subdivision Town of randview Parcel ID # (PIN#) Tax ID # Date: 04.138642 1112025 Impervious Surface: An area that releases as runoff all or a majority of the precipitation that falls on it. 'Impervious surface' excludes frozen soil but includes rooftops, sidewalks, driveways, parking lots and streets unless specifically designed, constructed and maintained to be pervious. Calculation of Impervious Surface: Percentage of impervious surface shall be calculated by dividing the surface area of existing and proposed impervious surfaces on the portion of a lot or parcel that Is within 300 feet of the ordinary high water mark by the total surface area of the lot or parcel, multiplied by 100. Impervious Surface Standard: Allow up to 15% Impervious surface but not more than 30% impervious surface on the portion of a lot or parcel that Is within 300 feet of the ordinary high water mark. A permit can be Issued for development that exceeds 15% Impervious surface but not more than 30% Impervious surfaces with a mitigation plan that meets the requirements of the Bayfield County Ordinance(s). Existing Impervious Surfaces: For existing Impervious surfaces that were lawfully placed when constructed but that do not comply with the standards In Section(s) 13-1-32(0) and Section 13-1-40(h), the property owner may do any of the following: a. Maintenance and repair of all impervious surfaces: b. Replacement of existing impervious surfaces with similar surfaces within the existing building footprint; c. Relocation or modification of existing impervious surfaces with similar or different impervious surfaces, provided that the relocation or modification does not result In an increase In the percentage that existed on the effective date of the county shoreland ordinance, and meets the applicable setback requirements in Section 13-1-32. Scanned with CamScanner ...........................: Impervious Surface Item Dimension Area (Square Footage) 2ft.X24ft. 1,088 Existing House Existing Accessory 36ft.X56ft. 2,016 Building/Garage Existing Sidewalk(s), Patio(s) & eck8t1X24ft.stairs4ft.X30ft. 6 Deck(s) eck8ft.X4ft.patio8ft.X24ft. Existing Covered Porch(es), ravel driveway8ftX138ft. 1,104 Driveway & Other Structures A Proposed Addition/House Proposed Accessory A Building/Garage New outside stairs &patiosl5'X20' 70 Proposed Sidewalk(s) & Patio(s) X30',5 X10',20 X15 Proposed Covered Porch(es) & A Deck(s) A proposed Driveway A Proposed Other Structures ,814 Total: a. Total square footage of lot: b. Total Impervious surface area: c. Percentage of impervious surface area: 100 x (b)/a = 2.am. If the proposed impervious surface area is greater than 15% mitigation is required. Total square footage of additional Impervious surface allowed: @ 15% @ 30% lsstaty Inrarmetfo. (cotmty use only) . .. - rate a irupwJw.. Laspeetion Record: Inning District ( ) takes Cznification ( ) t+1' Stormwater Management Plan Required: ... -.... .. _ ❑ Yes - ❑ No Slgrtaorrcof4upeaon Date ofApprwaL u#onm.rflaervioussurface Cleated: May 2012 (®Apr 2016; Sept 2020) Proofed by: Scanned with LD CamScanner AFFIDAVIT OF AUTHORITY (Corporation, LLC, etc.) PURPOSE. This Affidavit of Authority is used to certify the Individual submitting an application Is authorized when the property is owned by a corporate/business entity. STATE OF WISCONSIN ) ) ss. BAYFIELD COUNTY ) The undersigned affirms and states as follows: 1. Address of Subject Property: Li 6 3 `15 4fitu, v 0 Ca d l 'j 5 IiL 2. The Subject Property is owned by: il/e i,iez k h 13 I L (Name of Company) 3. The name(s) of the current President or Managing Member.1' d ( O it%_ 4. I certify that the company named in paragraph 2 is valid and in effect on the date signed below am the duty appointed agent of the Company named above in paragraph 2. and I have the authority under the terms of said authorization to submit an application to the Bayfield County Zoning Department concerning the Property described in paragraph 1. I further certify that the Information and statements made within this affidavit are true, accurate, and complete to the best of my knowledge. 5. I am authorized by the above -named Company to apply for and bind the Company to the terms and conditions of any decision or permit issued by the Bayfield County Zoning Department. 6. By signing this affidavit, I attest that I am unaware of any known or unknown person(s) who would contest this application. I agree to Indemnify Bayfield County or such person or legal entity suffering a damage resulting from any illegalities of the application. Dated:.1— /3_ -2Oz3 Print Name Subscribed and sworn to before me this day of L�JI. . 2026. No y Publi ,6FI County, Wisconsin My commission: Scanned with CamScanner i Land Use Permit Application Review Checklist Submission #: What zoning district is the project located in? $iR-1 ❑ R-2 ❑ R-3 ❑ R-4 ❑ R-RB ❑ C ❑ I ❑ M ❑ A-1 ❑ A-2 ❑ F-1 ❑ F-2 ❑ W ❑ M -M El Yes ❑ No Is lot substandard (does not meet current zoning dimensional requirements)? Deed of record: KYes ❑ No Is the project located in the Shorelands (Shorelands are lands within 300 feet of a river/stream OR landward side of floodplain OR 1000 feet of a lake/pond/flowage, whichever is greater)? Yes ❑ No Is impervious surface required? (Required if riparian lot OR lot is entirely within 300 feet of OHWM of navigable waterway) ❑ Yes P'Jo Is the project located in the Floodplain? Zone: Yes ❑ No Are there wetlands on the property? El Yes J0 Is project associated with a nonconforming use or structure? ❑ Yes 'Jo Is project associated with a variance? Case #: ❑ Yes JVo Is project associated with a Special B or Conditional Use Permit? // Permit #: ❑ Yes cJo Is the project associated with a Special A Use Permit? ❑ Yes o Does the project require sanitary? 0 Existing 0 New ❑ Intercept ❑ Reconnect ❑ Non -Plumbing O Public Sanitary Permit #: ❑ Yes ❑ No Does the project require mitigation? Implementation Deadline: Date of Compliance: ❑ Yes .-No Does the project require an affidavit? Affidavit #: ,Yes ❑ No Did licensed surveyor mark lot line(s), if project is within 10 feet of required setback? ❑ Yes JZJo Did applicant/property owner mark lot line(s), if project is within 30 feet of required setback? Project use is? esidential ❑ Commercial O Municipal Project type is? New Construction bkAddition/Alteration ❑ Change Use ❑ Relocate ❑ RV Placement O Sign ❑ Establishing a Business ❑ Temporary ❑ Shoreland Grading ❑ Other, describe: Structure Type is: KResidence O Principal Structure ❑ Accessory Structure ❑ Boathouse (one story only) ❑ Open-sided/Screened Structure (gazebo, etc.) ❑ Stairway to navigable waters ❑ Mobile Home ❑ Shipping Container XOther, describe njtuc c.scniz€..0.4 . Total Sq. Ft. of Project: 8O Number of Stories: Overall Height: Calculated Fee Category: esidential Principal Structures - $0.75/square foot (minimum $125) ❑ Habitable Residential Accessory Structures - $0.50/square foot (minimum $75) ❑ Non -Habitable Residential Principal and Accessory Structures - $0.20/square foot (minimum $75) ❑ Commercial/Municipal Principal Structures - $0.75/square foot (minimum $125) ❑ Commercial/Municipal Accessory Structures - $0.20/square foot (minimum $75) Calculated Fee Amount: 19 Additional Fees: g,Return Inspection ❑ Land Use Revisions ❑ Special Use Permit - Class A ❑ After -the -Fact (ATF) ❑ Flood plain Shoreland - Impervious Surface El Shoreland - Non -Conforming, etc. ❑ Tower Siting/Collocation 1 ❑ Tower Collocation 2 ❑ Metallic Mine ATF Fee Amount: Inspected by: C Co /j o LS L I�. Date of Inspection: r,f 2j ZS� Re -Inspected by: Date of Re -Inspection: Denied by: Reason for Denial: Date Denial Letter Mailed: Approved by: Date of Approval: Condition(s): Must meet and maintain setbacks from furthest extension of structure including eaves and overhangs. ❑ For personal storage only. ❑ For personal residence only. TVot for human habitation or sleeping purposes. ❑ Town/State/DNR/Federal may require permitting ❑ A Uniform Dwelling Code (UDC) Permit from the locally contracted UDC Inspection Agency must be obtained prior to the start of construction. ❑ A Uniform Dwelling Code (UDC) Permit from the locally contracted UDC Inspection Agency must be obtained prior to the start of construction (if applicable). taMUse best management practices to limit and prevent erosion during construction. ❑ This permit cannot be transferred if property is sold. ❑ A Bayfield County Health Dept permit is required. ❑ Check with Town regarding room tax. ❑ Short -Term Rental is for a maximum occupancy of persons. ❑ Sign must meet the requirements of Article E of the Bayfield County Zoning Ordinance. be constructed per plan. ❑ Adhere to privy agreement. ❑ Temporary permit allowing existing structure for a period of less than 1 year. ❑ RV may not be used for permanent residence or storage. ❑ RV allowed for ❑ RV must be removed by ❑ No sewer and pressurized water allowed in the structure. ❑ No plumbing or plumbing fixtures allowed. ❑ No additional sleeping areas allowed without obtaining necessary sanitary permit(s). f�}Land use permits shall be required for any new residence, any building or structure erected, relocated, rebuilt, or structurally altered 'Land use permits shall be obtained prior to the initiation of construction or a change in land use ❑ Requirements (e.g., permits/licensing/tax) of Local Town, Village, City, State or Federal agencies are required ❑ Sanitation requirements must be met (if applicable) ❑ Additional conditions may be placed and need to be adhered to at the time of permit issuance Other Conditions: B'-4'FIELD Bayfield County Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: Submission Number: NAMA KNB LLC LU-01619 13225 W HONEY LN NEW BERLIN, WI 53151 Transaction Number: LU-01619-2962F Description Amount Shoreland - Impervious Surface $25.00 Non -Habitable Residential Principal and Accessory Structures - $0.20/square foot (minimum $75) $160.00 Total: $185.00 Payment Amount: $189.40 Reference: 4877605625 Paid by: Todd Dejno Payment Type: Credit Card Transaction Date: undefined Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. Town, City, Village, State or Federal Permits May Also Be Required Substandard - / Nonconforming - No Shoreland — Yes / Impervious Surface - Yes Floodplain - No / Wetlands - Yes Mitigation - / Affidavit #: LAND USE - X SANITARY - SPECIAL A - SPECIAL B/CONDITIONAL - BOA - BAYFIELD COUNTY PERMIT WEATHERIZE AND POST THIS PERMIT ON THE PREMISES DURING CONSTRUCTION No. 25-0225 Tax ID: 38642 Issued To: NAMA KNB LLC Location: S35 - T44N - R06W Town of Grand View Legal Description: LOT 2 CSM #2199 IN V.12 P.429 (LOCATED IN GOVT LOTS 3 & 4) TOG WITH EASE IN DOC 2022R- 593299 Residential Structure in R-1 zoning district For: REPLACE CONCRETE PATIO [800 Total sq. ft.] (Disclaimer): You are responsible for complying with state and federal laws concerning construction near or on wetlands, lakes, and streams. Any future expansions or development would require additional permitting. Condition(s): See back of card NOTE: This permit expires two years from date of issuance if the authorized construction Scott Roush work or land use has not begun. Authorized Issuing Official Changes in plans or specifications shall not be made without obtaining approval. This permit may be void or revoked if any of the application information is found to have been misrepresented, erroneous, or incomplete. May 01, 2025 This permit may be void or revoked if any performance conditions are not Date completed or if any prohibitory conditions are violated. Condition(s): Must meet and maintain setbacks from furthest extension of structure including eaves and overhangs. Not for human habitation or sleeping purposes. Use best management practices to limit and prevent erosion during construction. To be constructed per plan. Land use permits shall be required for any new residence, any building or structure erected, relocated, rebuilt, or structurally altered Land use permits shall be obtained prior to the initiation of construction or a change in land use