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LAND USE PERMIT APPLICATION — Burnett County, WI a 2 c <br /> , <br /> Applicant Complete All Sections Below This Line c <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> 09 <br /> Dwelling/Principal Structure $300 x Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 '' <br /> CD <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \ EO <br /> 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 � r, <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 "� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692)ly)Structures $350 <br /> Filling/Grading $150 Boathouse $500 S 0' Ilk <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> z, <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> I E7 <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. -co <br /> Property Owner's Name: h By rLd& E ayd 9. z <br /> 9 0 • <br /> Property Owner's Mailing Address: 1500 YQr me. s.46%•13edr tat l'AN1 5%35 o <br /> 11 <br /> c. <br /> City State Zip <br /> Property Site Address: IACI06 Count �,QQ(i Ca <br /> Contact's Telephone Number: (Di a" 30Q— I WI z o (1-1 <br /> a o1 <br /> Contact's Email: Et3ou ci2xG @ SinCIA 1..COM o <br /> 0 <br /> Legal Description of Property: <br /> Section#: 09 Town#: 40 N Range#: ‘5 W Town of: UCLC,t S,o n o 0° <br /> 5. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* p <br /> Tax ID#(1-5 digit number; found on tax statement): 5a`$ <br /> Proposed Use of Structure/Addition: Garai e, Sari, -in-r_ -- 1., .. k9cce b v) <br /> J -� -1 <br /> Anticipated Start Date: L' 1 r (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> Building Contractor: SkY'UC UrCLi 13Uik&tn.5S Sewer Installer: 14/Pt 1 ° v <br /> tJ -j <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY )---- <br /> THIS <br /> JTHIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> **The applicant needs to contact their I DC inspector to determine if a permit A needed from them prior to <br /> .4.V I.construction taking place for any dwelling'. dwelling additions, manufactured homes, manufactured Z <br /> home additions, and bunkhouses.** <br /> 0 1\104- c( hL wt habi+a+;0n <br /> a Nees <br /> it { Cket r 4 O►� `- �a i� 100V / <br /> oZ <br /> ofx15_11, �}y�C .Ne exce� �cocM z Fee Rec: Ut-'' <br /> : Check#: ft,Zl,a <br /> 1 rri <br /> v <br /> Date of staff site visit: 31)64;2, Initials of site visit staff: 1 L ,_,L <br /> ' <br /> / , v <br /> • <br /> APPROVED BY LAND SERVICES OFFICIAL:G / , � <br /> // DATE:3�O `T /p� ` �,UPON APPROVAL: APPLICANT MUST POST COPY OF rrnrili <br /> z ©K lu ISIGNED PERMIT APPLICATION IN PLAIN SIGHT!3!---ml <br /> �'�Transcendent: - Page 1 of 4 4 -�Laserfische: - Burnett County, WI Land Use Application — Rev 12/2020 g r 1, <br /> v <br /> -1 <br />