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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 5' ►r <br /> Permit Types and Fees:(Please,check appropriate boxes) u-- <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 a: <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 c'1 <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 r�� `D <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ----, <br /> k) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 p <br /> Filling/Grading $150 Boathouse $500 r- p RI <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 o "� . <br /> CA lb <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. g <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,rglandscaping,etc. rD <br /> Property Owner's Name: V--/2410c,444 H Cr,c.F-Sj(jv1 52. 1� <br /> Property Owner's Mailing Address: ZAP I q mid 3✓ Me---31e47 v V / 5-013 o <br /> /ICity State Zip a <br /> Property Site Address: 3// /k0711 R-- <br /> Contact's Telephone Number: 7/C✓ ' 3 77• c3,5-5-62 PIP" o• c <br /> Contact's Email: k a -cr eau-1-r. ...-y1/i . 277'-v 1 0 <br /> Legal Description of Property: 5E- /1/' a ' V2 <br /> Section#: / 5 Town#: 3J' 9 N Range#: / 7 W Town of: L/`eso///1 <br /> N oa <br /> 5 <br /> uo <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> 7 <br /> Tax ID#(1-5 digit number;found on tax statement): 3,14:9-// g <br /> CA <br /> Proposed Use of Structure/Addition: Cckpt:V"`74 <br /> Anticipated Start Date: 'PX/517 (Home/Cabin:Commercial Business:Bedroom:Deck:etc.) <br /> t1):::::) _iBuilding Contractor: 'MMer can � A///1nstaller: A/� .. <br /> .1-1 <br /> r- <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 9.3 <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.** z <br /> ik1'5 IS OK. aE— /(^e. peo ►lM <br /> dr/ <br /> 4. <br /> L Ntf 6e- tt Se- C -fir hu w.4 n A q ir i4f4 i'i ,� <br /> Fee Rec: <br /> y Check#:W <br /> Date of staff site visit:Li Y" f /d—'1Ini ':Is o�site visit aff: z <br /> / rt <br /> APPROVED BY LAND SERVICES OFFICIAL: /� . DATFr'17/�f < �Q� <br /> m r- <br /> UPON APPROVAL: APPLI ' UST POST COPY OF a a 71`. <br /> 41 SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° z 3 70 <br /> {��� <br /> y n C.a� Y�Y <br /> Transcendent: - Page 1 of 4 a G na o <br /> Burnett County, WI Land Use Application—Rev 12/2020 04.z <br /> Laserfische: - 3Rill <br /> _.,. <br /> o <br /> • <br /> a <br /> v <br />