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LAND USE PERMIT APPLICATION -Burnett County, WI r <br /> b <br /> Applicant Complete All Sections Below This Line 5 <br /> CD I <br /> Pennit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 O <br /> CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G ;; <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °< ,. <br /> Filling/Grading $150 Boathouse $500 r- <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year 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. <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. N f <br /> Property Owner's Name: D Jn A«iI I ' Meiti vak, ih eA4 . 0 I <br /> Property Owner's Mailing Address: 132._ 157 oi Ave V e N W /t Mt)O Veg. ITN S536-1 i -�- <br /> 2345y old 35 Rd part bur Cit tate tate Zip <br /> Property Site Address: r tA54 5.3 v a' n (cs <br /> Contact's Telephone Number: 7(o3-350 " 7 71 'm::=. f c <br /> �^ n. <br /> Contact's Email: day YI(fit `R� 9rytai I ' Y1 d <br /> Legal Description of Property: Luh `a` C.St 1'5 31) 4 8' ? 3 0 (c t--4 W <br /> Section#: j t e Town#: Range � to W Town of: 0 -r.-sL o g° - <br /> LIU' N #: o =. <br /> CA) <br /> *Attach additional page i f needed fir lengthy description OR attach a copy of the deed OR attach tax system property page.* ClCh <br /> Tax ID#(1-5 digit number;found on tax statement): 19 g I I ,r)- <br /> Proposed Use of Structure/Addition: h O Me/C040 t V1 P C <br /> Anticipated Start Date: Li I ` <br /> 2 (Home/Cabin:Commercial Business;Bedroom;Deck;etc.) 9 ) i <br /> Building Contractor: tAV 4 C.t2- Sewer Installer: fipple--t.rts <br /> , (ii. — <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: CP <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to — <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions, and bunkhouses.** 70 <br /> 0 A1ee:4- a(( 5e t,S <br /> x Fee Rec: <br /> Check#: moo 7 <br /> Date of staff site visit: Initials of site visit staff: <br /> ,31d-5i 2-1 � <br /> �f <br /> �/ 311?-� 5..:w_.. <br /> APPROVED BY LAND SERVICES OFFICIAL: %i/ DATE: <br /> UPON APPROVAL: APPLICANT M ST POST COPY OF W °_........\�, <br /> Ril <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> IV <br /> Q <br /> Transcendent: - Page 1 of 4Ril <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 w <br /> a <br /> 4 <br /> -o <br />