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LAND USE PERMIT APPLICATION—Burnett County, WI a 5 <br /> r <br /> Applicant Complete All Sections Below This Line <br /> o' It., <br /> 0. <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> d <br /> )4 Dwelling/Principal Structure $300, Addition/Alteration to Dwelling/Principal Structure $200 , <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 Z <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 I 1 ll <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> tN Ui'' <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 j o< <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> c/P' h <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. I 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,landscaping,etc. CD <br /> g. <br /> Property Owner's Name: M A 111 e tt) �� cfr� ,iyl h�, -He �{ I, G'( h(y.. ' z <br /> Property Owner's Mailing Address: 6( '0 2 y� 6 t o �, .(Gl t i/ ivo(5 I <br /> . (/J' , City State Zi -o_ <br /> Property Site Address: Sg `i e I--?. ('(d Y} AGI) IA h.(k f, WI (7'f e"/...1ig- <br /> Si- aI.- 5a -4 '� <br /> Contact's Telephone Number: o g <br /> o. <br /> Contact'sh Email: / t, V 14 F ' � ( 0 YV) d <br /> LO?' 0 - '14t0 Sea, e r A ` ' - I 0- 1 i t..l vouv'e C 4 ceelko K <br /> Legal Description of Property 1 5 oty Phi6 iS 5 4u0nr.sC-d . G ' itiTC 1l�. a U�� t v <br /> L ;(.utSr oi'SIAs t.� NE, Civ. R�1f�{) ( <br /> Section#: 25- Town#: 3 9 N Range#: / O W Town of: <br /> s. <br /> 00 <br /> *Attach additionalpage i needed for lengthy description OR attach a copyofthe deed OR attach tax system roe page.*.f S Y P �1 property t'tl P S * C7 N <br /> 5. <br /> Tax ID#(1-5 digit number;found on tax statement): /1 ?L1 D <br /> Proposed Use of Stmctur / ddition: 1 ith h U FA C �-u L t a �m-e "—C\ . <br /> Anticipated Start Date/-1 <br /> , 1 /1j Li (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) / x <br /> Building Contractor:WMC- /U htl � r?/J Sewer Installer: /-6 pel iv j (i M vim/ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY :,...:Q <br /> . <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 then prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured Z <br /> home additions,and bunkhouses.** <br /> I ? (P1ee J 5e49g.ck 5 - <br /> Dvtielli etc 3 be- rov�S ;� <br /> v <br /> I``, i.oir o 3 Fee Rec:_[_— <br /> Check#: D5 <br /> IJ 1--- <br /> r <br /> Date of staff site visit:51y'2-I Initials of s' e visit staff: �'I a <br /> APPROVED BY LAND SERVICES OFFICIAL: ` t �� / DATE: 5151?-1 . r• <br /> OA <br /> UPON APPROVAL: APPLICAN ' ST POST COPY OF W W <br /> XJ <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT '1 a (tart <br /> 0c IV <br /> Transcendent: - Page 1 of 4 :;, N <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 ' 3 <br />