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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 <br /> CD 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) °- c� <br /> jpik Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <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 �\CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 q <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> G7 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> Filling/Grading $150 Boathouse $500 <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> c4 <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 /> j*Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. W E <br /> Property Owner's Name: 1�'�2 `JW�szO <br /> Property Owner's Mailing Address: i/ 8. (._(2-'re-/ C12flv.:-_•_ �— -,& z >; A Jam- Ht--, c-. <br /> City State Zip - <br /> Property Site Address: ZS 2C) ScAzt`� J c�r+5c1� �--k L r jt'tcs4t v tat..5---- s- -13 >' 3 <br /> Contact's Telephone Number: 5--(6.>.,-3 r'1 S. 63 tce o g <br /> a. <br /> Contact's Email: 4—etin 2-u,''2S e 3,0,1 , cc,vv-. d <br /> CD <br /> Legal Description of Property: LG-T- 3 c6 8, <br /> Section#: ZTown#: 4 0 N Range#: I W Town of: 6 2 T4-) <br /> it(a Ad.-- c w <br /> 5' <br /> *Attach additional page i needed or lengthy description OR attach a copyofthe deed OR attach tax system propertypage.* �' h <br /> PS .T f 8 Y P Y P P <br /> U <br /> Tax ID#(1-5 digit number; found on tax statement): 1• 6 (� r, <br /> Proposed Use of Structure/Addition: C.a l/q; '\/ 1.'t i `, <br /> Anticipated Start Date: (Home/Cabin:Commercial Business:Bedroom;Deck;etc.) —31=> i <br /> Building Contractor: rn41(2--C)cc_L-7S-a Sewer Installer: 4\4^S (3741.----C)2,cvi G,< <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: (r'_ <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.** , x <br /> 17Hee--- tel( 5e--t ctc-' 1-S <br /> v be- 1/4--5� 01/45 a 3 rc6i(k( a'l l►"� pet 54/11-21 -°7 <br /> Fee Rec ' <br /> Check#: A37 <br /> m <br /> Date of staff site visit: /-/// I Initials of'Ste visit staff:At, <br /> APPROVED BY LAND SERVICES OFFICIAL: 4 . 't ' ' DATE: 2-1049.-1 cam, <br /> UPON APPROVAL: APPLICANT M ST POST COPY OF N a n <br /> r <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT nlliiii <br /> 4-71P <br /> Transcendent: - Page 1 of 4 F <br /> ,. <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 $ <br /> 0a , giii) <br /> (.c ) <br />