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- <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> _ Applicant Complete All Sections Below This Line 5'F CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> 1:-, k <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ?: <br /> CD <br /> - Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> 'IX Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 �� <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 6- <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> G) IP <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °e <br /> Filling/Grading $150 Boathouse $500 0 <br /> Six Month Camping Unit(One Per Year) $100 _ Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cn lb <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. w <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. FS <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> CD <br /> Property Owner's Name: 4 )/ /Ailez .�-� T z ----, <br /> o <br /> Property Owner's Mailing Address: ��6/ G'T4-/ 4./mac £l_1`t Md CS-6 Vz S <br /> ����� City State Zip a. <br /> Property Site Address: AP-//7"-E-- /,cJE A/G.- r C4 <br /> ow- <br /> Contact's Telephone Number: :3/c.2. 0 /C9 / 2 -? o <br /> Contact's Email: /O G('//1 Z 14)5 i---/ ffi-i4-442.1.---f• ------`"-j)'14---- <br /> Le <br /> Legal Description of Property: Le-7—/3 ir'2 4-Ts'f it ,--. 4 /,yrs �S,','er 7 <br /> Section#: / 2_Town#: 3 7 N Range#: /'e W Town of: '72,132: -. L.4, — ��c °' <br /> °` <br /> cm <br /> 5 <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system property page.* <br /> P <br /> cii <br /> Tax ID#(1-5 digit number;found on tax statement): 332 /3 <br /> Proposed Use of Structure/Addition: L /qi- -- (j <br /> Anticipated Start Date: /-7. y /c"--- (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o <br /> Building Contractor: 42/(7E-- /. J7 Sewer Installer: ..__ <br /> * <br /> y W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY W <br /> W <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 , `1 <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes, manufactured z (-- lJ�' <br /> home additions,and bunkhouses.** <br /> eeecQt 5 <br /> NIA- �r lemma') l'Wb444. ''o'� <br /> es. <br /> Fee Rec: b� <br /> 4 Check#: i 0/Q 1.3 <br /> v <br /> rn <br /> Date of staff site visits /LI I a1 Initials of ite visit staff: <br /> / <br /> / pz <br /> l v <br /> APPROVED BY LAND SERVICES OFFICIAL:Elii4/DATE �/ �I <br /> mm r7. <br /> UPON APPROVAL: APPLIC • MUST POST COPY OF ° �' 70 <br /> ; <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT '' o <br /> fiit <br /> Transcendent: - Page 1 of 4 la <br /> ca Q <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 [jlll <br /> H,,, <br />