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r <br /> LAND USE PERMIT APPLICATION —Burnett County, WI <br /> <. b <br /> m 1 N <br /> Applicant Complete All Sections Below This Line o <br /> E. <br /> Permit Types and Fees:(Please,check appropriate boxes) °- W <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ;}�� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 1 <br /> e\'' Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 - Addition/Alteration to Bunkhouse $150 !r <br /> 5-1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ,-, ;s`--.. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 < II 1 <br /> Filling/Grading $150 Boathouse $500 r <br /> c ;v\ <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 O <br /> *NOTE:After-the-fact permits(permit squired after construction has begun)may cost up to three times the normal fee. ) D <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. V� <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. -c <br /> - g 10 <br /> Property Owner's Name: l Yat ) iO 1k�� b <br /> Property Owner's Mailing Address: s a CO v,r,4 Qc\ C- 0 1.16 ulr 633 l i <br /> f �y City 'State Zip <br /> Property Site Address: `3-a 7(0 Cpur.�ti �c1(� IJ in�v c uu �1� y`�S O <br /> r,1 Yr <br /> i.Telephone Number: k a-OS-Y 1"10 ��}y� o <br /> ( 1 � 1-J a <br /> Contact's Email: __�o i�� �3t M� �.c�rr 1 <br /> Legal Description of Property: LOQ )\ C5 M .33 4O VOL Ho? 115 <br /> Section#: S 18 Town#: O 3O N Range#:215 W Town of �)c otJ r <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system properly page.* y <br /> Tax ID#(1-5 digit number:found on tax statement): S 3I <br /> Proposed Use of Structure/Addition:E x-4 a' 4 <br /> yf ek7Ne cieca. >Z. I, ) A,'J,, <br /> Anticipated Start Date::.3,,,a3 1 (Home akin;Commerci 1 Business:Bedroom;Deck;etc.) 7 X <br /> Building Contractor: A r,t,,t, r �-k-ee1 Sewer Installer: i�l iA 1--) -3 1( !� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ] <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Q1 <br /> THIS <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to 10 <br /> ANY construction taking place for any,dwellings,dwelling additions,manufactured homes,manufactured 'z 9 iCr-N <br /> home additions, and bunkhouses.** z <br /> I Nd.\— ,&7f. h wrenlet,b3A4,.04s ee( a6( SeI- - S <br /> Fee Rec: I5 <br /> 4 Check#: Luh <br /> d <br /> Date of staff site visit: 5 I d-5/02- I Initials o site visi aff: L a <br /> APPROVED BY LAND SERVICES OFFICIAL:Og jl DATE:"rO T < <br /> UPON APPROVAL: APPLICA // UST POST COPY OF . Q.w a <br /> 'i $ 5 SSI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 o a <br /> •Transcendent: - Page 1 of 4 w- 4 <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 <br />