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• <br /> I<I, > ► .j s `l,t ' <br /> LAND USE PERMIT APPLICATION —Burnett County, WI ,��I cr <br /> IIS, 4 41-giro ` `ti <br /> Applicant Complete All Sections Below This Line 5' c <br /> CD 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) A <br /> p( Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d U <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 O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 P <br /> C.) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> q <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° d <br /> Filling/Grading $150 Boathouse $500 <br /> r <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. E. <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. 44, <br /> Property Owner's Name: /7e Cj I//2 C �M,/� cX 64(c LLC <br /> 0 <br /> ,�A <br /> Pe) J �] <br /> Property Owner's Mailing Address: iiiii. i. F! Pec, 60y %4,4lc �E/C4(TdlClf7 /"6/ qVi o <br /> n City State Zip $ , <br /> Property Site Address: T D 0 LA lice 3 la/', � Nb r'/y A// Sy g3 0 W <br /> Contact's Telephone Number: a /4- a(e5 . C�.08; M4/29/2 o c <br /> a. <br /> Contact's Email: lv►,.cNI I d k( CC 5g1116-7i a A UC9, (`6(41 d <br /> R <br /> Legal Description of Property: g,,,- Ce.)( 3 IX PCS g 33-d,r7 ,gC2e) <br /> --<:---. R <br /> N as <br /> Section#: QC, Town#: 4/4N Range#: /5" W Town of: ..c:,t.5} ,� <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* C7 <br /> Tax ID#(1-5 digit number; found on tax statement): 416 110 <br /> Proposed Use of Structure/Addition: ,C4x,1-, e /e'44(A_1 '7z> cA <br /> Anticipated Start Date: f pr)/ 402 Cel ) (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> Building Contractor: PfriU(k ea($R.41 go me-i Sewer Installer: AD,e4✓t f 61;?8,3 i/ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: i <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, <br /> rn TCns�d bunkhouses.** <br /> be �� lkli;uses.**, b ��f )-2-- C. 2-.1. - ^ 2-.1 <br /> sv <br /> deetess Oe439- ' kse& tizwzuki <br /> 0,1 hse- <br /> x Fee Rec: <br /> u u o <br /> Check#: Of Jdi 933 <br /> Date of staff site visit:-i/b I)."1 Initials of site visit staff: L(I <br /> / /im <br /> APPROVED BY LAND SERVICES OFFICIAL: �'{t /, / DATE: l/tl A < r <br /> '% <br /> UPON APPROVAL: APPLIC • 'T UST POST COPY OF a <br /> .n a3 Xi 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT %g Nliffil <br /> Transcendent: - Page 1 of 4 ' 111 N <br /> Laserfische: - Burnett County,WI Land Use Application —Rev 12/2020 rl <br /> ro <br />