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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> • 7..... ro <br /> tJ <br /> o. <br /> Applicant Complete All Sections Below This Line 0_ <br /> -A <br /> Pe rn)it Types and Fees:(Please,check appropriate boxes) r---- <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d d <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 r,.,065! <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 , <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 C <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 e° <br /> Filling/Grading $150 Boathouse $500 r <br /> Six Month Camping Unit(One Per Year)) $100 Permit Extension(lYear Extension-Allowed Once) $100 <br /> v) <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. ' milil <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. E.7. IP <br /> \ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ro I' <br /> Property Owner's Name: Cj W %4 V 1 \Ikk iii, <br /> Property Owner's Mailing Address:45 3 9 Salmi, ?4 ?d Wetellerlfsli 5415? <br /> -� �" <br /> citv. State Zi N <br /> Property Site Address ( g f Q,c�-, vook. Rd W etoskv WI S'4 1c 3 r 2 ' <br /> 5(o (Q -0 9'l <br /> Contact's Telephone Number: 1 (5 _ y <br /> Contact's Email:S C,O\Y 1tY hQt-liv,Q'--\a.k t • CotAd <br /> , <br /> 6 <br /> Legal Description of Property: <br /> Q o as <br /> Section#: 3 Town#: ! N Range#: i7 W Town of: VtCD In = <br /> *Attach additional page if needed for lengthy description OR attach <br /> a copy of the deed OR attach tar system property page.* <br /> O <br /> 5. <br /> Tax ID#(1-5 digit number; found on tax statement): t 0 1101 -., <br /> Proposed Use of Structure/ dd' ion: 11. \e; vl <br /> Anticipated Start Date: Sf l-1'2021V.A (Home/Cabin;Commercial Business;Bedroom, Deck;eic.) -1-.4 0 x <br /> -( _ ° <br /> Building Contractor: S-}'eV� QC)SS OW Sewer Installer:. I o((0.hdev <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMIENTS/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 s <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured z <br /> home additions, and bunkhouses.** I / <br /> 0Al� eXG4€ 0i barvDLK.S pG^ SaNli744y Sf/S I . <br /> & ktei (q td a k, p e r yv„AS ... r 497148r 'cce c 5 oe y <br /> thue i I e ras dy ON2o2./, <br /> - Fee Rec: (�— <br /> s Check#: it .2 <br /> 7. <br /> Date of staff site visit: 1-176/1( 1/. <br /> Initials of site visit staff: ' J Z <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 03720 Zt < aDin= °' <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF F <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z s <br /> SC IN.1 <br /> Transcendent: - Page 1 of 4 sq C <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 Cb <br />