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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> • b <br /> . Applicant Complete All Sections Below This Line g 0 . <br /> Permit Types and Fees:(Please,check appropriate boxes) n <br /> t7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 w <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> rlf Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to mink cruse $150 q <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk unkhouse $25_12. .-' ; <br /> Driveways/&Campground Structures $125 9 84I(1v)Structures $350 51 <br /> `` <br /> Filling/Grading $150 Boathouse $500 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits q begun)mayup "' _A <br /> (permit aquired after construction has cost to three times the normal fee. 5_ <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> g.- <br /> I <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc a % <br /> r g <br /> Property Owner's Name: 4br1 -; LA'& e H �bi t 2St v i ^ z <br /> Property Owner's Mailing Address: 1‘2.32 V i e V./ i Chimp It n +rl N C 33i(n o <br /> City State Zip .o <br /> Property Site Address: 2 21 VI, Li•S j— : 3 <br /> Contact's Telephone Number: vh C.4 II (r 12-`1!-�C.O., l1.02°‘ IA54_IX' OZ i‘ •1(03..q 13‘11113 .It* r <br /> m <br /> Contact's Email:den-J hOfS€h g CLQt it prof IQ.%.v oriLs _NI+ c7 <br /> Legal Description of Property: ltL2. CSMA 2-12 .‘i <br /> J 1 P2. 3-6(Su truis: ie;( 1d RZT Lb1lc,Le-r ` NL\ <br /> b <br /> Section#: l3 Town#: \ N Range#: 14 W Town of l`'�u��k, tis 4 1�� °o <br /> 5' <br /> go <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> ' <br /> q. <br /> Tax ID#(1-5 digit number,found on tax statement): 35'2. <br /> Proposed Use of Structure/Addition: e }'a e,1 Witt kbuse, i' <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> ' <br /> Building Contractor:`,Q 1 e n Sewer Installer: 1 <br /> 0 <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 <br /> home additions,and bunkhouses.** L / / Po <br /> LIM <br /> © frviuSf //0/.9 c-40mc i 54 i s a s OU7y„Ne.,/i4 V19 Z0- o3 <br /> Fee Rec:a5O 42. <br /> o Check#: -2 Y59 <br /> 7/...- <br /> cz <br /> Dateof staff site visit: (2/I 8' ZO ZD Initials of site visit staff: �i /t r <br /> APPROVED BY LAND SERVICES OFFICIAL: �, _ DATE: VZ-6/Ze al < r ''—'; <br /> n s." <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF y w Fg 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 2.o pil <br /> Transcendent: Page 1 of 4 II <br /> N <br /> Laserfische: 115 <br /> Burnett County,WI Land Use Application—Rev 6/2020 g " <br /> CI .. <br />