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LAN LP UNE YL+ K1V111 AYYLILA 11VIN — Burnett County, WI a <br /> 'b <br /> 7: v; N <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Please,check appropriate boxes) °' <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 w <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 J <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> A <br /> `/ Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 � <br /> A Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° „` <br /> \ <br /> Filling/Grading $150 Boathouse $500 �1 <br /> - G� <br /> 0 1 <br /> Six Month Camping Unit(One Per Year) $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.51.211.4.i Ph""c. ;' <br /> s <br /> Etc// fro.n 1/tuti <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc.i:ari v-f. 5i,. ,.,-.J 1b/0,1 -o <br /> 41/o?3.co. r • <br /> Property Owner's Name: J eah^e M Pc-iter-sen o <br /> Property Owner's Mailing Address: 3 a 3-5- t&se vowel Lane /\(. P1 y en ou-'l t IN NI 554141 g <br /> day State Zip LS <br /> Property Site Address: 7,9 VI 5a n ci Lake ,Q,1 Vie b 5 r W r 54 gel 3 E. <br /> 1 <br /> Contact's Telephone Number: JCAnne cell l i 3- 35b-,),..g3 0F 1 <br /> • c <br /> a. <br /> Contact's Email: rite 'Sen.jeanne. p 3vncxi l , Com o <br /> Legal Description of Property: Pet (OV Lor I (Suet/E5t'1r 30' RD F <br /> � CD. <br /> 35t/ti F-bR 0i IUEW q) N <br /> W ES <br /> Section#: 16— Town#: q O N Range#: IT W Town of: J ac-ksonf 3 j37 °o <br /> ,i <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system propertyPu e.* <br /> P <br /> .'T <br /> Tax ID#(1-5 digit number;found on tax statement): 56,3 I n' <br /> Proposed Use of Structure/Addition: Re I�ecl ro i-in f tn•,ber re�'ainiAn wilt f stairway <br /> Anticipated Start Date: C.001 Ore A --3i mtn€ (Homet abin:Commercial Business;Bedroom:Deck:etc.) .5 x <br /> �' ,Able <br /> Building Contractor: 6o,cth'wt.,' Sewer Installer: WA <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY .---N <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 pA <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured z 0 <br /> home additions, and bunkhouses.** x 3 <br /> I(1:3 5 ( e f ?e 01,4' -( r e: ;i, <br /> X11 -E 56,tIrwo AL1- was Sone c A-i i r;p ( <br /> 11n5t+ '01 <br /> o Qwce ,exp � IA ; <br /> = Fee Rec: 1c09-7- <br /> _ <br /> Check#: 1,124 <br /> ' <br /> ,,, <br /> Date of staff site visit:5/ 1 al Initials of site visit .ff: I, L 0D <br /> z <br /> 0 <br /> ri <br /> 1 m <br /> APPROVED BY LAND SERVICES OFFICIAL: / 6 DATE: III�I < <br /> I nrr, „- <br /> UPON APPROVAL: APPLICANT UST POST COPY OF D a liifil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° -. Efifll <br /> <m N <br /> ' 0O <br /> Transcendent: Page 1 of 4 IN <br /> N <br /> Laserfische: - Burnett County, WI Land Use Application — Rev 12/2020 al <br /> Lc—"`--Dj <br />