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LAND USE PERMIT APPLICATION — Burnett County, WI a `° <br /> b <br /> v, Nio <br /> Applicant Complete All Sections Below This Line 0 <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> )( Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ?: <br /> co <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 /> ____3..„...... <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° /v <br /> Filling/Grading $150 Boathouse $500 0 OS <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> CA <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/ <br /> > as:pergolas,landscaping,etc. <br /> Property Owner's Name: /�/4JCS C.�ti4 A f L 771/Ale s 0 <br /> 79'74, <br /> (� / n v eel ye a1 L-(( <br /> Property Owner's Mailing Address: / 7 7�P L�R E"��/G°� /� C' S. o , <br /> _ City State Zi <br /> Property Site Address: 4PPL/e,9 f• A) 5S'o# r. <br /> Contact's Telephone Number: 9.5/01 �J29d) 0 g <br /> Contact's Email: /L-C/1 il. S,4 . Y4)15.6 , e 42 --,,e- <br /> Legal Description of Property: a 7" 6.3,1 —a" Y/ -3S'o? c5 ©od "lilac � ..,�V\ <br /> Section#: -2s Town#:4 N Range#: /4 W Town of: ,�W SSS = °C <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system propertyPa e. <br /> C7 <br /> V <br /> Tax ID#(1-5 digit number;found on tax statement): _<4 ! <br /> Proposed Use of Structure/Add.tion: ^�� "' <br /> Anticipated Start Date: ,s o w <br /> p . 10/4b or (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ( , , x <br /> Building Contractor: Sewer Installer: / r'12ile)Ali W = a <br /> .i W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: t --s� <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 /> (}leer J 5e-4 ccits <br /> ms's et S4N�al-39 <br /> �, NA- '172 exceed � leo P <br /> Fee Rec: <br /> ` <br /> I11- <br /> z <br /> v <br /> Check#: 04 <br /> Date of staff site visit:5/ 19(a I Initials f site v'.it st. • , <br /> �/ 2 LP v <br /> APPROVED BY LAND SERVICES OFFICIAL: / DATE:5/ I I m �..J <br /> Fi Fp <br /> ff <br /> UPON APPROVAL: APPLICANT '' / ST POST COPY OF a a� n <br /> r3 —c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z h ag <br /> Transcendent: Page 1 of 4 � raw C <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 <br /> o a _ 5 <br /> rn3 <br /> b <br />