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LAND USE PERMIT APPLICATION— Burnett County, WI to <br /> rn IN) <br /> Applicant Complete All Sections Below This Line 0 <br /> PP P CD a i <br /> Permit Types and Fees:(Please,check appropriate boxes) ,...... <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d 00 <br /> CD <br /> Commercial/Industrial Structure se Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industria coAddition/Alteration to Bunkhouse $150 ro <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 Z <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 5 , <br /> Filling/Grading $150 Boathouse $500 t- I, <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cn <br /> *NOTE:After-the-fact permits(permit aqui red 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 /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. k <br /> Property Owner's Name: k /1 160 c Z-/,/6 h —Thr -S 7 o <br /> Property Owner's Mailing Address: 6 3 / t�!i,C0e cP i €- ,'F,, (i(,,/ 6313743 g P- <br /> J <br /> Ty State <br /> 1p <br /> Property Site Address: i // " �4sz.e J�tr e.,zs �71 gQ.� LT: <br /> '' <br /> Contact's Telephone Number: 6.12 7 .c? --0 2 7.5 o c <br /> a. <br /> Contact's Email: 1I,v1Ld rct.5(, ermS 644.770ac"... dR <br /> , <br /> Legal Description of Property: 3,e 4.A <br /> Section#: g(o Town#:3 ? N Range#: / W Town of: -2-2_r10�►'t o ao <br /> Lr <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number;found on tax statement): /6 '7' 3 / ` / R. <br /> Proposed Use of Structure/Addition: 5-779 ,�t.Q•��. �kt.c' d Mem[G ect 4941---112/0_1✓ �, rr' - <br /> �/ y o l, <br /> Anticipated Start Date: �— > (Flame/Cabin,,Commercial Business,,Bedroom;Deck,,etc.) `OC-Ge/ 6 <br /> Building Contractor: �je,n 5J y-e� 44 L Sewer Installer: H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY rp <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 .!' W <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured hones,manufactured z <br /> home additions,and bunkhouses.** <br /> 0 MO:Auft il►+Perv' 5kr,6ces Mea' as a-c N/13/?)• Ay Mom W it <br /> rep,,,;re. Milt a-h'o n <br /> � 5 <br /> s Fee Rec:_I 7 <br /> LOCO_ I Check#: r7'�5' <br /> V;],J' tr <br /> 6 <br /> Date of staff site visit: Initi is of site visit a;• z, <br /> JCS <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: LI/a3 l I rn <br /> < m t! u <br /> // mac. D <br /> UPON APPROVAL: APPLICANT ''''4 T POST COPY OF sl f 3 0 <br /> Gifil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Transcendent: - Page 1 of 4 x 3 ^U <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 12/2020 z a , _Eiji <br /> i <br />