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cn <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a ,am <br /> p. iv <br /> Applicant Complete All Sections Below This Line a hr <br /> Permit Types and Fees:(Please,check appropriate boxes) _ <br /> Oweliing/Principat Structure $300 'Addilton/Alteration to Dwelling/Principal Structure 5200 <br /> 2 <br /> Commercial/industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure 5200 <br /> Accessory Structure(Garage,Shed,etc.) r";'1 s Addition/Alteration to Accessory Structure S1S0 <br /> Accessory Structure(Commercial/industrial;) 5200 Addition/Alteration to Bunkhouse $150 $ <br /> Deck/Stairs/Patio/Retaining Wail/Sidewalk Bunkhouse $250 i r <br /> Driveways/&Campground Structures $125WI State Statute 59.692(1v)Structures 5350 1 <br /> Filling/Grading $150 `Boathouse ZOO <br /> �, <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Mowed Once) _$100 i g <br /> *NOPE:After-the-fact permits(permit squired after construction has begun)may cost up to three times the normal fee. a r l'‘*Communication Towers&Signs require a different application form;see corresponding application,and fees. i ' <br /> "items not listed above will be treated os accessory structures,such as:pergolas,landscaping etc. <br /> Property Owner's Name: . .t TT (1 L_KeNz: P.% <br /> 0 <br /> Property Owner's Mailing Address: 1140 if.7 Tot'Qs/ • " c AL_ 5o3 i ti <br /> City State Zip <br /> Property Site Address: 2.6 96! Q t Vir Gs/(xt #fL G,/t,sAri- i✓r •5'{rj1:3 <br /> Contact's Telephone Number: I—CS 1 -,Z 4.3/S/ <br /> a <br /> � <br /> � , a. e <br /> Contact's Email: , e{f M l`7 g j d►aR/'i&'C. i ( "n , <br /> Legal Description of Property: adell 10 _,w. 4 tj(,tJ 5E 54i6 CSAi i- 4 q31030 <br /> o 'V <br /> Section#: Town#: N Range#: W Town of: r''){M Zuw <br /> *Attach additionalpage i needed or lent description OR attach a o the deed OR attach tax stern property page.* <br /> f f lengthy P copy fS3 P pe pas t7 <br /> t� S <br /> Tax ID#(1-5 digit number;found on tax statement): //(9 41 <br /> Proposed Use of Structure/Addition:_ ee/ f C <br /> Anticipated Start Date: _ lot 209I (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) f <br /> Building Contractor: L-eS,Gty 5ewfr1staller: (.P H ❑ a <br /> AREA BELOW THIS LiNE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 1� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Ct 1 T--, <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 0 <br /> home additions,and bunkhouses.** xi <br /> 6(heeA—Nee ( ��e,(1,6- So( Cc4( o(+ ;& be;il 10cSter , <br /> re[ p i 5 bat <br /> qVa �` a FeeRec: I5 <br /> 6 Check#: q(41 1 <br /> 5/Lill i <br /> Date of staff site visit: Initials f site v' it staf <br /> 2.'/ %i C3 ' <br /> APPROVED BY LAND SERVICES OFFICIAL:_ . , , /��_�_� DATE:���� <br /> UPON APPROVAL: APPLICANT, ' ST POST COPY OF <br /> o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o --< .. , <br /> `.< ri; <br /> Transcendent: - Page 1 of 4 m o w <br /> Laserfische: - 1 Burnett County,WI Land Use Application—Rev 12/2020 5 co C <br /> 3 <br /> �oJ <br />