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LAND USE PERMIT APPLICATION- Burnett County, WI a <br /> b <br /> Applicant Complete All Sections Below This LineC c o <br /> Permit Types and Fees:(Please,check appropriate boxes) n <br /> A <br /> Dwelling/Principal Structure $300 %, Addition/Alteration to Dwelling/Principal Structure $200 O <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 ....?I F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °< <br /> Filling/Grading $150 Boathouse $500 r• <br /> Six Month Camping Unit(One Per Year o E <br /> ) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. k T, <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. F7D ;- <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 77 <br /> Property Owner's Name: R m it i- cr AA O2 r A Wi�' , g ' <br /> y vs I 55.110 P <br /> Property Owner's Mailing Address: 5z. 00 c�41AkL1 A $ S u'N a 3 b E1)iYvq vn N o <br /> p rty 2 e I C 5 C } IS`rkvvb �Ic 1)n City State Zip o <br /> Property Site Address: '` <br /> Contact's Telephone Number: a YZ4 ze-So iv 1 1S--5 SA-24,3 S o <br /> • c <br /> CD <br /> Contact's Email:_ _ bra,d tom- etes-SOIy L34, Q v imok;r 'to " o <br /> Legal Description of Property: PLL 9 o V Lo•T S 3 $ b Des( 50\is i 1 (P .. ` *3) �' <br /> � N o <br /> Section#: I tb Town#: 4{ 0 N Range#: t 1 W Town of: 5 C_O.TT!-- _ a <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): I 81 5 ' <br /> Proposed Use of Structure/Addition: S U IvRoom 1 Otcc/ \-K *(%itk. ®) 1 y <br /> Anticipated Start Date: rn y - t o-2O ti (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) rte( o k <br /> Building Contractor: 5'e..Nk..5 (3„/ COy`ST LL L Sewer Installer: Vit t X3\ 9-) O <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.** x0I'tt 'sei-lo,"tCiS <br /> el Dwel6� ro- e.cceec 3 becroo✓rts Qef 54N 353037 <br /> IP ( jvei d- 9°aC�+I+5114 (1 4- }v be 519:4- l✓1(09T Pe( Fee Rec: <br /> 401 hw✓nan b,la r2C0— <br /> Check#: O(a� <br /> u I <br /> PII)41-1 <br /> Date of staff site visit: Init'• sof ite visi`aff: i J a , �. <br /> ,_ <br /> P 1-Ai,/�/ l'i(3a)j <br /> APPROVED BY LAND SERVICES OFFICIAL�A -..7 4•7q.,-- <br /> ,,,DATE: <br /> UPON APPROVAL: APPLIC •N '►' ST POST COPY OF �_ 0? <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° - N <br /> C2 Q <br /> Transcendent: - Page 1 of 4 n <br /> PO <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 6/2020 ri <br /> rn0 <br />