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s b r <br /> LAND USE PERMIT APPLICATION —Burnett County, WI <br /> Applicant Complete All Sections Below This Line 5 c - <br /> Permit Types and Fees:(Please,check appropriate boxes) o. <br /> b. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 v 00 <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 �' C <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 K <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. - <br /> *communication Towers&Signs require a different application form;see corresponding application,and fees. R. -9 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. L_, <br /> J M fie*er-s,e r, <br /> Property Owner's Name: E�+-�'►n e • z <br /> Property Owner's Mailing Address: 3(235 Ro*et,JooeAr�ae- N f• PIymdlc ) M N 555j41 i C. \ <br /> aeZip <br /> Property Site Address: 1794q sand Lake Lbsfer, Wt �� �3 a n <br /> r„ <br /> P <br /> Contact's Telephone Number: 6 4-Coen ?et1-er3Cm1 (o loZ-8t)a-9gS r . <br /> L ca <br /> Contact's Email: 54-euet-,,�ett-erser a jma..I. com e-I <br /> Legal Description of Property: P CL CxbV L OT 1 (5(,l i3J 1 ESmT 3 0' 1?D f 35 64 I F'o1i;p I?iUF) <br /> 5WAY/ S <br /> lection#: oZ Town#: #0 N Range#: l S W Town of: J QC.ks o r-i <br /> .11 <br /> ( i%1 E3ntiT 3t3 7) <br /> Attach additional page if3:neede forlengthy description OR attach a copy of the deed OR attach tax system property page.* I <br /> fro <br /> Tax ID#(1-5 digit number;found on tax statement): 51.3 i n. <br /> Proposed Use of Structure/Addition: �ct` l'` ' e kr Arran (2—Al So r y addi+1-11 p,r, 16: x a8') r4 <br /> Anticipated Start Date:A 514-P- (rla.y 1-7 6JL*1l -iome/Cabin;Commercial Business;Bedroom;Deck;etc.) P s <br /> Building Contractor, Nle- -S ictal n t,‹. �e- Sewer Installer: Jackson II-01400�O 11 <br /> a <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 'W <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from then;prior to r) <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured Z <br /> home additions,and bunkhouses.** LPzz <br /> IO D vJell,' nab- 'IV e.KC ac- ) roo,a25 rt S IV I-9 <br /> g Neee, ermmk �( f twLi <br /> ee; rem; vli � B. I a'� 1 <br /> x a W <br /> Fee Rec: <br /> �j (� f yo <br /> Check#: __ <br /> Date of staff site visit: v/m(�! 2-I Initials of site visit staff: <br /> �j/ 7 2l o <br /> APPROVED BY LAND SERVICES OFFICIAL: I i l` / � DATE:v/// /? M sr,: <br /> � <br /> UPON APPROVAL: APPLICAN' 1511 <br /> �MUST POST COPY OF c w XI 0 <br /> y <br /> 3.3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° o g �' <br /> N <br /> Transcendent: - Page 1 of 4 " <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 12/2020 0 1 Rill <br /> M » - <br /> Lca <br /> b <br />