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LAND USE PERMIT APPLICATION - Burnett County, WI . q51
<br /> Applicant Complete All Sections Below This Line g �
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<br /> Permit Types and Fees:(Please,check appropriate boxes) °
<br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 e
<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
<br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 0
<br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250
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<br /> Driveways/&Campground Structures $125 WI State Statute 59.692)ly)Structures $350 °e
<br /> Filling/Grading $150 Boathouse $500 t—
<br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100
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<br /> *NOTE:After-the-fact permits(permit aquired 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. ° i
<br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc.
<br /> Property Owner's Name: Pt4 tat.! NC.NN 1 Ar C' /I -tr; t .c 134,.Y AS o z 1'
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<br /> Property Owner's Mailing Address: 3'7 37 S7/ZR7r'6,,u X//v(, gRu,;t<-Le,,,,, t"/4k/ Av TYVJ a `P
<br /> City State Zip -0
<br /> Property Site Address: 2 9 gC 7 01 c r C R V A (sac e6 74 743 t.+l:v W t sy g3 0 E-'. rcn
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<br /> Contact's Telephone Number: -7(.3-"3(00- T`/yt/ o y
<br /> Contact's Email: o,u el i2 rill c,,PI ,p t. vi,, h c s-c`-.,,y1ti , i. C c,,,, dIN,
<br /> Legal Description of Property: $ c 7,C "Tis/ y/ JL/4 4T/ C r7 V aP//.2. (N'w C W, �.
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<br /> Section#: 7 Town#: y/ N Range#: f W Town of: S t v t tS "'
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<br /> *Attach additional page if needed,for lengthy description OR attach a copy of the deed OR attach tax system property page.* p V
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<br /> Tax ID#(1-5 digit number;found on tax statement): 2.2-ye y
<br /> Proposed Use of Structure/Addition: SIL; ly%SD r"
<br /> Anticipated Start Date: "_J"t,e Ai L .2c / 24.) 21 (Nome/Cabin;Commercial Business;Bedroom;Deck;etc.) 0 =
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<br /> Building Contractor: /U,,,;7at A.Ai" �t,,e.nlryCI Z14..Sewer.Sewer Installer: NM
<br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY
<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 theist prior to th
<br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z (f)
<br /> home additions,and bunkhouses.** z
<br /> Nak- �wfil �aij;�410//
<br /> filed- Al 5e4"b'`
<br /> = Fee Rec:
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<br /> Check#:
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<br /> Date of staff site visit: 5 Initials of site v'sit staf : z
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<br /> APPROVED BY LAND SERVICES OFFICIAL: 4 .d, :e.." DATE:6/XO/01 / x
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<br /> UPON APPROVAL: APPLICAN ��� UST POST COPY OF a
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<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° s
<br /> Transcendent: Page 1 of 4 m .n 3 N
<br /> Laserfische: -
<br /> Burnett County,WI Land Use Application—Rev 12/2020 : '
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