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LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> _ AppIicant Complete All Sections Below This Line 0 c <br /> Permit Types and Fees:(Please,check appropriate boxes) °- KrDwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 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 . O <br /> F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 1 <br /> v Deck/Stairs/Patio/ aining Walidewalk Bunkhouse $250 <br /> � <br /> D vewayG1 ' <br /> s &Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° . L <br /> Filling/Grading $150 Boathouse $500 C ' <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100 P <br /> tn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 5 <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. ip <br /> n 16 <br /> Property Owner's Name: 1.4 LC--C PAT RAE, l l C?L sc.,/,) ° z , <br /> p <br /> Property Owner's Mailing Address: e l( et K.1-7040 R:1) (JvQ_./23/eA t r-Slb?.? c <br /> City State Zip -a I <br /> Property Site Address: &1. �{ P R tVLv R 0 <br /> Contact's Telephone Number: 6 / 2 - do 2- - 3 3 S o h <br /> • c <br /> Contact's Email: G/4 L E L EK14?4 ( — e 6 N4 A t L , cc-141 a 0 <br /> Legal Description of Property: L'+ . d QS{'lel 't/,j 67 kr 5 P 9 7 <br /> N -v <br /> Section#: (.2(p Town#: 3 9 N Range#: /G7 W Town of: Wt E E.,luta) 0 04 <br /> 5. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deedwOR attach tax system property page.* d <br /> Tax ID#(1-5 digit number;found on tax statement): 3410 to f 6. <br /> S <br /> Proposed Use of Structure/Addition: Q EP At& Pao i-331taa rnaoL'c i e4 /fr/LcANS r" <br /> Anticipated Start Date: /02 W(/4-y 26"1 ( (Home/Cabin;C n:merctal Business;Bedroom;Deck;etc.) 4,CD o <br /> o d <br /> Building Contractor: Sewer Installer: <br /> H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY c6 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: RS O <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 —home additions,and bunkhouses.** x <br /> 2 No e. 14 i '! e <br /> /Ab5tr e c s c eas <br /> ale �1 Ce' <br /> Fee Rec: /-1.61-22 <br /> t7; <br /> Check#: 8/30 <br /> LI !'2-7/2-(Date of staff site visit: niti: sof si visit st: . : <br /> APPROVED BY LAND SERVICES OFFICIAL:'.!, // D• TE: 1lUPON APPROVAL: APPLIC ' 1' T .3 POST COPY OF ��® <br /> -Q <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z l <br /> Transcendent: - Page 1 of 4 8 g c <br /> ^3,. <br /> Laserfische: Burnett County,WI Land Use Application-Rev 12/2020 < ��` <br /> om Uutl <br />