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e4 ' -!�S 2, q - z-tO t <br /> • LAND USE PERMIT APPLICATION — Burnett County, WI f <br /> b <br /> Applicant Complete All Sections Below This Line g <br /> Permit Types and Fees:(Please,check appropriate boxes) \ °- _ <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure '5200 <br /> C) UJ <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure `$200 <br /> X, Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse 250, z —f <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 r <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 o s <br /> vn k <br /> * OTE:After-the-factpermits(permit aqui red after construction has begun)may cost up to three times the normal fee. = a <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. ;71 <br /> Property Owner's Name: 0s Dyrer /02 Sine vl , a Yes o z / <br /> ,, f /c)/ o I; <br /> Property Owner's Mailing Address: /14-� I./tidy 6 3 Yl eta 2.1CI k m,( '4 � , o <br /> / �j C < City State Zip <br /> Property Site Address: 2;101 c 0 (d 71 rek, , (iv y 5 4'8 71, <br /> 1 ci' II <br /> Contact's Telephone Number: 15 Z (D - q 5-4' °-` <br /> ' <br /> n. <br /> Contact's Email: ayn A 1/iS Q J-( 44 , Low d <br /> Legal Description of Property: 07- yob- 2..--) -1)- 10 -5- 05- -OJ-Z - ()2 'Oo© C <br /> c oro r <br /> Section#: C t Town#: 3� N Range#: t `j W Town of: rakYi j AL3 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> iTd <br /> Tax ID#(1-5 digit number; found on tax statement): 1.72_ <br /> Proposed Use of Structure/Add' ion: 4-(0 M. e 4-- De-�C.k e C)c ." r€ ,, <br /> Anticipated Start Date: LI 15 r ZO2-t (Home/ Cabin;Commercial Business;Bedroom;Deck;etc.) £ x <br /> o e <br /> Building Contractor: D ' ev- 'Da X15 Sewer Installer: A- 4 .Jy 2,4(e_ <br /> HD1Z5) <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: N <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to N <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured z <br /> home additions, and bunkhouses.** I ,,/ / z <br /> 06,,,,are.... <br /> /10,'" 6� N S I -tct ^ ,4 a wta vl Ab'7 i,4b . <br /> Ned 4C//e--744e?//l vn S 9074C—.14n4 4 6//� j; <br /> �ek�' 4LD2 *a <br /> Fee Rec: <br /> Date of staff site visit: 9 8 geOl Initials of site visit staff: ,.//' u_ 3z <br /> o , <br /> a <br /> r <br /> APPROVED BY LAND SERVICES OFFICIAL: I,�.r_ DATE: 0°7241°1 < '�—��-_� <br /> UPON APPROVAL: APPL CANT MUST POST COPY OFC <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° y Q G� <br /> :. 0 <br /> Transcendent: - Page 1 of 4 T ,'•- CZ <br /> Laserfische: - Burnett County, WI Land Use Application -Rev 12/2020 g <br /> o . - PO <br /> a <br /> Lam—"7J <br /> 3 <br />