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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> Applicant Complete All Sections Below This Line o. <br /> Permit Types and Fees:(Please,check appropriate boxes) p- 'CJ <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 a d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200t Tt'J <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration toAccessory Structure $150 `V I F <br /> ><Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ct- <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 111 <br /> Filling/Grading $150 Boathouse $500 r <br /> .C.' �. <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. E. `* <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: gem vle 1A Ei---rGr.-d7 i eilG&j n-i F&rn//y1� v. ° / <br /> c <br /> Property Owner's Mailing Address: Pd 5,0X 1.-/g%� kill 51-g' 2 °c <br /> City State Zip <br /> PropertySite Address: 253'0 5-febte-e--.F.GCCel 35 a <br /> Contact's Telephone Number: 7/5.377'' 55 0 o N t[ <br /> c <br /> Contact's Email: tit It -dab/eC L. ✓ aII <br /> 2 e DO.Le-n---1 ro0 <br /> Legal Description of Property: <br /> o w <br /> 4 <br /> Section#: 2$ t <br /> �I Town#: N Range#: /CO W Town of: T►/I 01/1 o. <br /> *Attach additional page i needed or lengthy description OR attach a copyofthe deed OR attach tax °0 <br /> p g f f g y p system property page.* C <br /> Tax ID#(1-5 digit number;found on tax statement): 3.2 e-7600 <br /> Proposed Use of Structure/Addition: I11in i 5/vr 7e e_. (T <br /> \\ <br /> Anticipated Start Date: eX%s-/i'/?�j (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o <br /> ✓/ /l/� <br /> Building Contractor: 5d-r- Sewer Installer: N n H e <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 a-. <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> CZ <br /> home additions,and bunkhouses.** z <br /> l I II ZS l'S ail Q -7 e.- TatGi - efP-4I/ <br /> stru � /o„ A _„os.1 4 pp mei pet, VF Z/--O,S- <br /> re/t/ory Si' 1/ar/aut.�. cm144:44405.. l <br /> Gal <br /> ' I �` / J ��, Fee Rec: <br /> NO fp be- us 1�1� f'lG( lMQl�1 �Qf7/ t�l c-,-, Check#:_ <br /> �/2-9(?I �. r- <br /> Date of staff site visit: Initi. of /e visit z <br /> �j x <br /> APPROVED BY LAND SERVICES OFFICIAL: Q, '� ����/ DATE:"73/� < <br /> UPON APPROVAL: APPLIC ST POST COPY OF a BOJ <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° zc.. 1::. <br /> Transcendent: - Page 1 of 4 rn x .3 <br /> INZ <br /> Laserfische: Burnett County,WI Land Use Application—Rev 12/2020 n r` l( <br /> c <br /> 3 gill <br /> LTJ <br />