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LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> " Applicant Complete All Sections Below This Line 5'c <br /> Permit Types and Fees:(Please,check appropriate boxes) \ o. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d lr <br /> ' Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 i <br /> "X', Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \ ' <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G� w",-- <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o \L <br /> Filling/Grading $150 Boathouse $500 r, , <br /> Unit(One Per Year) ° <br /> Six Month Camping ^ <br /> $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cn <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. ro p <br /> Property Owner's Name: /i Ina Alt , .tz di - z �• <br /> P <br /> Property Owner's Mailing Address: W617 16.0_<s / , 41 _ ,ylh by1/(J 57036 i <br /> / /' City/ . State Zip .o <br /> Property Site Address: 4P/I > „cf >�'�,(. Ct h �v✓y APE S'?{&'. p = n <br /> Contact's Telephone Number: _763 --WY'-Z6 9 c y <br /> co <br /> U <br /> Contact's Email: OCkeii/0 Vial i ' , Gc7 n. <br /> d <br /> co <br /> Legal Description of Property: ‘(69./ g-:l `4 geJ <br /> N <br /> ro <br /> Section#: 1 g Town#: 4"f N Range#: i S W Town of: -5-IA)i� -5.5 D a <br /> 5' <br /> *Attach additional page if needed for lengthy description OR attach a <br /> copy of the deed OR attach tax system property page.* O <br /> Tax ID#(1-5 digit number;found on tax statement): ?/ [ Z1/ <br /> Proposed Use of Structure/Addition: ,S11r)r41 _ <br /> Anticipated Start Date: v,-z PI i 2,201-1 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) d <br /> Building Contractor: NO("1-4 lay )5Ui(di 4-3_5 Sewer Installer: JI/ <br /> H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY !-.) v) <br /> C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: , cp <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.** ;v <br /> ppitee4-- all se+b s , <br /> Nd+- kr kvi'n? 11.4,I9l k-4.. <br /> 3Neecc <br /> o�Q-f' �ba �-{, b Q�1i1hedi 'nom <br /> x Fee Rec: / <br /> N Check#: Q,ttSt+ <br /> L JA� <br /> Date of staff site visit: 5) 19 <br /> 41 Initials ,f site visit staff: u <br /> ci= <br /> i <br /> � �. <br /> .� <br /> APPROVED BY LAND SERVICES OFFICIAL: a � '%/,- DATE51�/�I) <br /> 37. <br /> UPON APPROVAL: APPLICANT UST POST COPY OF . .7 gjil` <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ' C3 o <br /> o' res <br /> Transcendent: - Page 1 of 4 : g tl��r1 <br /> Laserfische: Burnett County,WI Land Use Application—Rev 12/2020 , a <br /> I <br />