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LAND USE PERMIT APPLICATION— Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line a. <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) a C 1)) <br /> . <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $1500 O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 1 <br /> CYJ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °< --I, <br /> Filling/Grading $150 Boathouse .$500 c N ^r <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 '" ^ lb <br /> r II <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. = <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. <br /> 0 • <br /> Property Owner's Name: ii5t 7Qtt1 d Ma('t./ Ala Iii 6A o <br /> ' <br /> Property Owner's Mailing Address: --71q1,--71q1, lba di ki e-.k Lail Al. Aletpkt&&cve 1A S`S 3// <br /> 0 1 <br /> ,City State Zip 0. <br /> Property Site Address: 'O3 Co . ke ad 4 We, . 1 f 1 P' <br /> Contact's Telephone Number: '7(4 3' 362)" i 3407 " v S <br /> Contact's Email: Er((1.4�a ei PI -4 J� �% �ji�YJC{,r'�� (9G��PY( . e <br /> i. <br /> Legal Description of Property: 401 <br /> / // N '-o <br /> Section#: /t Town#: 4'0 N Range#: 11 W Town of: Sec,i-7- ° °0 <br /> s. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system properly page.* O <br /> Tax ID#(1-5 digit number;found on tax statement): /82/7&• =,' <br /> Proposed Use of Structure/Addition: .' S e dtS)Y) p i)r(/i <br /> Anticipated Start Date:, . jy#y r 2./ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) k <br /> Building Contractor: fie Z Sewer Installer: /V4 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: V <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 V <br /> home additions,and bunkhouses.** f- 19/0-1 <br /> pv <br /> aNee (,Ila,;✓1 ``- R <br /> () Nev.) deck w•II be 7ar-4-- em 01-W M . <br /> s Fee Rec: 06 <br /> o Check#: f 20P <br /> Li <br /> /ail <br /> n � r <br /> Date of staff site visit: ! f it/al <br /> Initials of si visit st f:I", za <br /> c. <br /> APPROVED BY LAND SERVICES OFFICIAL: / DATE: 5�3/PI '` r- <br /> �f�)J <br /> glif <br /> UPON APPROVAL: APPLICANT M 1ST POST COPY OF °r co a n <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ` o a w <br /> fig <br /> CD C NJ <br /> Transcendent: - Page 1 of 4 r Q <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 < m <br /> C . r. <br /> a <br /> L- <br /> 7 <br /> "0 <br />