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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) d° <br /> AC Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 cji <br /> e, rj <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 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °n .. <br /> Filling/Grading $150 Boathouse $500 0 a <br /> Six Month Camping Unit(One Per Year) $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. c• • <br /> r114*Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> lb <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. W <br /> Property Owner's Name:!MIG M*, J ;ut> f eie iul iit-It',s// f6#1 r✓` 4J4/'i"-re-4' ,O �-I o <br /> 1-3 Property Owner's Mailing Address:ych,8 iNdefiC e45r f 0 l�(,l%1 t le"k/,F,�i!4 /ti ) 537/U °o - i <br /> City State Zip W 11 <br /> Property Site Address: ,3C f r/al v&) L i e f)emr p44.74,4y iv/ s�'.�.— �' n M <br /> Contact's Telephone Number:4 7-2y7 449, (714o,v,i +k s/--dg9'--5-0.9/(61_ . . I <br /> a. <br /> Contact's Email: 4t h1‘rre n (4)- CL)Ala-61r /104-- ?e f ti'/&-Ter',m (O4IC'c 5f r'el- d <br /> Legal Descripti )of Property: PC L Ca L r>Z(/Rti� CD <br /> Section#: L. Town#: 4/1N Range#: /5 W Town of: �lJlj„..5 ° °G <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach?a copy of the deed OR attach tax system property page.* p <br /> m. <br /> Tax ID#(1-5 digit number;found on taxi statement):s /J <br /> Proposed Use of Structure Addition: ' / <br /> Am, <br /> `h <br /> Anticipated Start Dater i 0 A0110 (Home/":-7bin:Commercial Business:Bedroom:Deck:etc.) ° <br /> Building Contractor: / P5 Cc11 41e 1 eh , ,'VI4.0S Sewer Installer tr <br /> -3 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/ NDITIONS ONLY —THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: (A <br /> ?''The applicant needs to contact their UDC Inspector to determine if a permit is needed from then?prior to <br /> ANY construction taking place for any dwellings,dwelling additions.manufactured homes,manufactured z <br /> home additions, and bunkhouses.** x <br /> — Bu►"Id119 /cgblr) I1eC1r tAe_. fu - i/ 6c. IA"Cs/N gpaci <br /> DNI or f-h€ Parcel r+luSi" be Sp!) 71" /k1 7119 <br /> / G <br /> per, ,/1�p,/ 0 <br /> �10 Q re rr' ���^^"""'rr, s ' S z Fee Rec:'�'� <br /> 4 Check#: /So 9y <br /> / rn <br /> 6 <br /> Date of staff site visit:315[ / Initials of site visit staff: L r <br /> v,„„f <br /> APPROVED BY LAND SERVICES OFFICIAL: 4 /t /', DATE: dtc-(4 , <br /> 1 ,. <br /> p. <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF g 1o . <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT '- TH <br /> i. o Ca <br /> Transcendent: - Page 1 of 4 `l .. <br /> Burnett County, WI Land Use Application —Rev 12/2020 . <br /> Laserfische: LNdi <br /> ,1 <br />