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LAND USE PERMIT APPLICATION-Burnett County, WI a § <br /> . N <br /> _ Applicant Complete All Sections Below This Line o <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) . �-- <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 r vAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250Driveways/&Campground Structs" :s $125 WI State Statute 59.692(1v)Structures $350 5rCFilling/Grading $150 Boathouse $� g' % <br /> Six Month Camping Unit(One Per/pr) $100 � Permit Extension(1 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. F.�n <br /> ill <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ,•& r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name....1 -I „�;t Po rl i K9-{o✓t �`fw •••4• K i M ;p v <br /> fiefs m <br /> � �'1 <br /> Property Owner's Mailing Address: 9IV 5t (A) / Z 4{ 1.0 549A U;.e(.J d T W\A), r33 $ <br /> City State Zip M <br /> Property Site Address:Pi 11-/le 11.)', , <br /> sk 1 cl ?-\c:), `/"6j f�n�Sh,,(7 iAi 1 0' <br /> Contact's Telephone Number:Jnii K I`2.LI F Q S I Z 0 / (9 7-Z L(g-A l t s ° 22 '�. <br /> Contact's Email:TUS'?1_p 1tS® uo,tc4S(. IV e-i-/k Vvve.,t i a Li -c, q Ivill . aM b <br /> eo <br /> Legal Description of Propertyn'c j „Z- Z n 3 g i ct S w S i E.I- W Ll SO c 11.z. ti$k L �t- <br /> �0 <br /> Section#:t2.1 Town#: 3 9 N Range#: i QW Town of: U;eS\. %t is \,h o Iti d b <br /> a' <br /> 3, <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system propertyPa8e.* e , <br /> y <br /> 51 <br /> Tax ID#(1-5 digit number;found on tax statement): tg e <br /> j ' <br /> Proposed Use of Structure/Addition:, \ mc,.;D ©,„,,2_,./._ ^,(L&0 <br /> Anticipated Start Date: <br /> I ems. 4 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> i 7 . <br /> C7 <br /> Building Contractor: Sewer Installer: ui <br /> y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/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 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z CP <br /> home additions,and bunkhouses.**, .. / r P' <br /> 0 /VS� 7!7 6e_ o t-air A u !AAA," A a 61 ra,40A , <br /> 0 TVS is a ppm_ year' ex/ems/. -Qv p e rwl/i-G up z0-z 73 <br /> &hal i,*I'!f /180 eiC?/1€. Dl^. WOZ020. Fee Rec:`/)n <br /> 6,3 Check#: bD -33 <br /> Date of staff site visit: `7 �,7/v Zi/ Initials of site visit staff: J /' <br /> 0/W <br /> ifi0 <br /> APPROVED BY LAND SERVICES OFFICIAL: _ DATE: e../ <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF y <br /> MI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 ?g 0 <br /> m = Ger <br /> Transcendent: - Page 1 of 4 P y o —' <br /> r) 0c <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020iv <br /> `' N <br /> i 1gig <br /> Lc----DJ <br />