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• <br /> C4 "Ci <br /> LAND USE PERMIT APPLICATION - Burnett County, WIr <br /> cr <br /> a r b <br /> Applicant Complete All Sections Below This Line o' c <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d J <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \�O <br /> AccessoryStructure Commercial Industrial $150 CD <br /> (Commercial/Industrial)) $200 Addition/Alteration to Bunkhouse <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G7 <br /> Driveways/&Campground Structures $125 x WI State Statute 59.692(1v)Structures $350 0- N <br /> Filling/Grading $150 Boathouse $500 C- <br /> Six Month Camping Unit(One Per Year)) $100 Permit Extension(1 Year Extension-Allowed Once) $100 cn � <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. a <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 /> r p_ <br /> Property Owner's Name: 1)o s e_p' N \ — & k ° z <br /> Property Owner's Mailing Address: ,3 3159 E. `110, P. ��OC D .b...e-y li.)s. '5'(E30 o <br /> rCity State Zip $ <br /> Property Site Address: 0.875q C. Y-k,a,..-7 (ZvvQr agl. , pct-v•.bu-.+'y `•)5 9483D r <br /> Contact's Telephone Number: (O 7) aloe( - ci as-co F <br /> Contact's Email: 3\K-'r,&Lk' 0 .a-5 t b AA_ C:,MA.A <br /> 1. <br /> Legal Description of Property: Lai " ` A't;Isirk C--)0-..ra S Rwt-r P:Ae 5 .. <br /> Section#: 18 Town#: U O N Range#: I W Town of: (.0c-i‹.t G.v�� <br /> o aro <br /> 5' <br /> cm <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): I LI 3 1 to <br /> kProposed Use of Structure/Addition: ci r•e P k'Vie "v-; ,r .r� -7i... -� ��- �p�C v, <br /> Anticipated Start Date: 3 tsn.dv�e_c 0-:-Ir? (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) X <br /> . d <br /> Building Contractor: 1.11 k Sewer Installer: NA/,A r r <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY .- <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: e` W <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.** <br /> x Fee Rec: 350•00 <br /> o <br /> Check#: lb(`y q <br /> Date of staff site visit: �.Z/ ZO Z( Initials of site visit staff: �r '- a <br /> 411 �— srr, r <br /> APPROVED BY LAND SERVICES OFFICIAL: ,, DATE: .-02-74-0 Zi < "_, j <br /> Viiil <br /> UPON APPROVAL: AP ' ICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 2 f,:, Guy <br /> O <br /> Transcendent: - Page 1 of 4 = N <br /> LandUse Application- <br /> Burnett County,WI A lication–Rev 12/2020 <br /> MI <br /> a <br /> 3 <br />