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LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0' c <br /> Permit Types and Fees:(Please,check appropriate boxes) ' i , <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 6' <br /> 'V <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> C. Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ' W <br /> � <br /> W <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 V <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 .►) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> Filling/Grading $150 Boathouse $500 r <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> In*NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 0. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. i <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ro <br /> ti <br /> Property Owner's Name: 6(yee4t 6Xvv (e— 11 r4Y1C/ y t or. zQ J+ �� ► M <br /> A <br /> Property Owner's Mailing Address: 1 1 I G l i n f� 11�e 5 f3 jooal kA i 5J`t o <br /> Property 1�6� 1 l€i Lome. eb fer at i4(a Zip 7 , <br /> Pro a Site Address: <br /> Er---::\ <br /> Contact's Telephone Number: G 14 . 1144"4136 o r, • <br /> Contact's Email: il t «n 10'11 10 U) '' ick 4�� , CO d <br /> Lai" <br /> ^^ Al ,1 ,/�31 i m <br /> Legal Descrii�jjtion of Property:L)i" �,() f 1 i �`� V tJ 1- 1 -' a� v <br /> Section#: AL6 Town# 40 N Range#: (5 '� N b <br /> W Town of: 4.0 6 a t 0 0° <br /> 5" <br /> *Attach additional page if needed for lengthy description OR attach a�copy of the deed OR attach tax system property page.* O <br /> 1-1 Tax ID#(1-5 digit number;found on tax statement): 4 <br /> Proposed Use of Structure/Addition: r,.r't (' t' r' <br /> fp ° <br /> Anticipated Start Date: PI, ' ' , � ome/Cabirt,,Commercial Business;Bedroom;Deck;etc.) x <br /> Building Contractor: �t,A`)5Ci1 3 LICA Sewer Installer: <br /> • d <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: \� L <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.** 7d <br /> tj Meer\-- q(1S (L1oc LN Gen+e live, <br /> 0 Nc4. 6, t,tivim lekc,,b).4raoill <br /> Fee Rec: I 5641 <br /> 0 <br /> Check#: 62.64 <br /> m <br /> Date of staff site visit: 4 Initials of ite visit staff: AL z <br /> al APPROVED BY LAND SERVICES OFFICIAL: I, '`e',1 , DATE: 1 i 30/ <br /> s 1 < <br /> Fi ' _,.CJ <br /> IR <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a in <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 4 Q 3 70 C: <br /> •• a)- " (nr <br /> � � <br /> Transcendent: - Page 1 of 4 g p eco <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 < o a Q <br /> w m <br /> a <br /> 6 1l`=J <br />