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- LAND USE PERMIT APPLICATION — Burnett County, WI b <br /> -I_ _ Applicant Complete All Sections Below This Line 0 <br /> Pelmit Types and Fees:(Please,check appropriate boxes) <br /> 0 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 vCP <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ? <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 r-..._ LI <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $2504'" '4 <br /> n <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 $' 05 <br /> Filling/Grading $150 Boathouse $500 r <br /> Six Month Camping Unit(One Per Year) o "`•--PD <br /> $100 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. 0. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 2 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: t ...if Tk J G' 4 C z <br /> Property Owner's Mailing Address: nt 41-Lif 0 0 <br /> ^� i City State Zip 53-dig. <br /> Property Site Address: '37351(,E UtL/S 1.-� Ase Lex, P(973 E <br /> Contact's Telephone Number: '7(57—Pi' 'O&OGS T .i✓') ^- • Fi R <br /> ` o N ^� <br /> Email: U Lt -\., a <br /> Contact's Emai <br /> ✓en.t�u�' L r�.5t'�7'iew�"�faTl'I1�i�,r=c. ►�1 /� d <br /> Legal Description of Property: t-Ot i L )71 I/ 15 9,4 (6c''✓ LOT 7) <br /> Section#:-..-35—' Town#: 110 N Range#: t 6 W Town of: 0Q,k I464 0 0° <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* O <br /> Tax ID#(1-5 digit number; found on tax statement): If l OO, � <br /> "6. <br /> Proposed Use of Structure/Addition: (54, ' (, �(je "' <br /> Anticipated Start Date:.6 -j,_ (Home/Cabin;Commercial Business:Bedroom;Deck;etc.) k <br /> d <br /> Building Contractor:rDL iE/Z4ZG- Lqr int Sewer Installer: t 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ^� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to 0 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z V\ <br /> home additions,and bunkhouses.** z <br /> 0 Ai et i be, u5 c.ci -G P A ti IMC,K ka L t'fQ lte0YL_ <br /> 0Go <br /> x Fee Rec:10o <br /> y Check#: C2'-f <br /> 0 <br /> Q / <br /> Date of staff site visit: 3920z/ Initials of site visit staff: ii r //!J�!T rZ I <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 09/00174/ nm i o -� <br /> rii <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ; w <br /> ,, <br /> lgl <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT = <br /> Transcendent: - Page 1 of 4 x r "`—►' C <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 r.1 . <br /> 0 Lc........_,.. <br /> 0 <br /> cn <br /> a <br />