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LAND USE PERMIT APPLICATION— Burnett County, WI a
<br /> Applicant Complete All Sections Below This Line o'
<br /> Permit Types and Fees:(Please,check appropriate boxes) .-
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<br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 �
<br /> Com I Industrial Structure "—
<br /> y► rSier / $300 Addition/Alteration to Commercial/Industrial Structure $200
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<br /> .., em.-c�sserl ed,er1-7,-5e Addition/Alteration to Accessory Structure $150
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<br /> Accessory—Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150
<br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G7 \ \A
<br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0
<br /> Filling/Grading $150 Boathouse $500 C.
<br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l 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. t/
<br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. a
<br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. y%
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<br /> t; /!^�„ l?� �a..nc�,�� l{ ._.)0.,11 Property Owner's Name: Y ,` z1 4
<br /> Property Owner's Mailing Address: co S 5. E n e Y �J '. I a,,,,,d„,,,„,...,, a) , 5a) a z
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<br /> 1 City State Zip a N [\
<br /> Property Site Address: 40�,�4, (L./c -- Lip`ett Li, tFct Sploner (Air 5,(c30 tF. cny)
<br /> Contact's Telephone Number: 6—Cs '1 ' y°t -04i 5 it o E
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<br /> Contact's Email: 5 )7 S e c 'e mQ,t (i.. CI"41 d
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<br /> Legal Description of Property:Lt4 (04'1 C.S'/7l 1 I •Pq A&3 G-Ov r i- Orr 17 i n F
<br /> Section#: j 3 Town#: 39 N Range#: ii--iW Town of: R U Sk 5 '
<br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o N ..--..\
<br /> Tax ID#(1-5 digit number;found on tax statement): I S. 21 O 5
<br /> Proposed Use of Structure/Addition: _IP_cs..;Z Kiln u,..se. _ t
<br /> -Anticipated Start Date: o!'t---1 -- LU'l4 . 1'Jq[ief,e/Caom;commercial Business;Bedr._m;Deck;etc.) 'fib F x
<br /> Building Contractor: Q LO Ae r Co..6 3(,) Sewer Installer: ,p�/� au It/7 ict = a.
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<br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF CONINIENTS/CONDITIONS ONLY
<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 Q
<br /> ANY construction taking place for any dwellings, dwelling additions, manufactured homes, manufactured Z
<br /> home additions,and bunkhouses.** z
<br /> 0 611 01/0 all coat44 V-io,tS' as mu//N�1 I VAR— i —,O1
<br /> gC®vis/vuc to h 1A)0 S2-?1"74-41i, ,Aouf ,ails ,f-e"417
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<br /> © � 'S 5 �-- 15 4 b u n k 1,o�t`��� Fee Rec: p� to
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<br /> 4 Check#: 77
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<br /> Date of staff site visit: Z 7•2' Initials of site visit staff: if /!J f� I rn>
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<br /> APPROVED BY LAND SERVICES OFFICIAL: ,a4it DATE: .7/ °Z."/ < W r
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<br /> UPON APPROVAL: APP "CANT MUST POST COPY OF g�, m C
<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° la
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<br /> Transcendent: - Page 1 of 4 n N
<br /> Laserfische: Burnett County, WI Land Use Application— Rev 6/2020 m 3
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