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LAND USE PERMIT APPLICATION- Burnett County, WI c b <br /> 164 <br /> Applicant Complete All Sections Below This Line 0 c <br /> Permit Types and Fees:(Please,check appropriate boxes) n <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d T-- <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 /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250mlib <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 w <br /> Filling/Grading $150 Boathouse $500 r- <br /> in Unit(One Per Year ` <br /> Six Month Camping g ) $100 Permit Extension(1Year Extension-Allowed Once) $100 � <br /> cn <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. ic <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. q <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> CDk <br /> Property Owner's Name: M c c a„�.d, 1 \CLN R A kv,�4.,." o F <br /> Property Owner's Mailing Address: P0-Bs.f 1 11 W eJos`ker- VJI. S-1$ et 3 8 <br /> City State Zip <br /> Property Site Address: cg ► 1 0 ire vvw .le-0 ot.-d W sJo s1l.e.-1 WM s4 gel 3 ' <br /> lip <br /> C y <br /> Contact's Telephone Number: l,,,d 11 - $ 03 - 3 P 9' � OP' _ F <br /> Contact's Email: et‘Cx.rk-- k.v..e.1....,, C) t.oyv..C.o.S+, v- e_ d <br /> d <br /> g <br /> Legal Description of Property:(.4:4- a LSM#H s q I)aS P 4+7 (04.... ..)la 13 a 4 0 3 .. <br /> N .c <br /> Section#: 0(a Town#: 39 N Range#: ((a W Town of: IA exkccr‘ S, °C <br /> 5 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* p <br /> 79 <br /> Tax ID#(1-5 digit number;found on tax statement): 34 0 (p ' <br /> Proposed Use of Structure/Addition:S}tD r" <br /> 7i 7i <br /> Anticipated Start Date:f 0. c, 1 v (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) - . .,„ <br /> g _ <br /> Building Contractor: e AAA' c.s .. M.. ,,, Sewer Installer: ..------ - <br /> la ckZ•. <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 ' lA <br /> home additions,and bunkhouses.** Po <br /> Or 4 OA^ CO( ktanCO 114.13.140L.4*,Y1 <br /> epTineerv:0,44 S ,ie.r (lax ( 0-1.51z) <br /> 0 m Fee Rec: /AJC J ill <br /> Check#:/ <br /> Date of staff site visit:"1 57 d"I Initials of site visit staff: Z t r <br /> ci <br /> APPROVED BY LAND SERVICES OFFICIAL: 1' ,,./09 ,...."- DATE:DATE: It40.1---- < <br /> UPON APPROVAL: APPLI ,,Ik" ' .UST POST COPY OF " :1' ° <br /> a <,3 <br /> m <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ? o z, <br /> Transcendent: - Page 1 of 4 w'` <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 < 2 ff <br /> D <br /> 3 <br />