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LAND USE PERMIT APPLICATION—Burnett County, WI a b <br /> ,7' y N <br /> Applicant Complete All Sections Below This Line a- c �' <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ?: <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 XI <br /> ( <br /> Accessory Structure(Garage, -tc.) $150 Addition/Alteration to Accessory Structure $150 ' <br /> 4. <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 <br /> Filling/Grading $150 Boathouse $500 o P 1 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> V A <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. $ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: IV i C k O 1 G S K . M u e L L"€ r o <br /> Property Owner's Mailing Address: a p 9 W CCC R o 4 L luau F y s-tri 30 °o k <br /> (Cc. <br /> � City State Zip b <br /> a� <br /> Property Site Address: Vo ^^��Ro 4 0 a _. <br /> Contact's Telephone Number: C e i ' (D I d.. -- SCO — CA ' 13 o <br /> a <br /> Contact's Email: ® N o <br /> Legal Description of Property: PC 1 NW SE 4 SW SE ( Lot la D -67 S ) <br /> Section#:AIWSE Town#: 1.1-1O N Range#: R 1 LO W Town of: fS A K kANb <br /> tKI <br /> Icopy a' <br /> *Attach additional page if needed Ior lengthydescription OR attach a of the deed OR attach tax system property h <br /> p <br /> Tax ID#(1-5 digit number;found on tax statement): 1 3 1 b W <br /> Proposed Use of Structure/Addition: S feelp > S+OR WJE S NO - ,o 1- 1 N I4 A ITV ) "' <br /> Anticipated Start Date: U NE -3. L y . (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) �-� o x <br /> ,_ yy�� � d <br /> Building Contractor:N©R+ �.A N t lw 1 I cl 1 i1)AS Sewer Installer: ]V A <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY W <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 them prior to <br /> ANY construction taking place for any dwellings,dwelling additions, manufactured homes,manufactured z <br /> home additions,and bunkhouses.** I • �' <br /> \/d,\- �f {' toi 4/), ha b,'\-cc�c3h <br /> s Fee Rec: /V6-3 til <br /> y Check#: s IV <br /> / o <br /> Date of staff site visit: /(! I?--1 Initials of site visit toff: ✓ y <br /> 7,Z 5/?/?-/ '�APPROVED BY LAND SERVICES OFFICIAL: qiPel., DATE: � <br /> iIiiii <br /> UPON APPROVAL: APPLICANT i 1ST POST COPY OF W <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 1 --c g15) , <br /> Transcendent: - Page 1 of 4 = n <br /> i5 <br /> Laserfische: Burnett County, WI Land Use Application —Rev 12/2020 <br /> x <br />