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LAND USE PERMIT APPLICATION — Burnett County, WI c <br /> _ Applicant Complete All Sections Below This Line 5 <br /> Ca 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> C3 <br /> Dwelling/Principal Structure $300 1, Addition/Alteration to Dwelling/Principal Structure $200 It ^I� <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 f <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ' 1 <br /> a ' <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 CT <br /> Driveways/&Campground Structures $125 WI State Statute 59.692)ly)Structures $350 <br /> Filling/Grading $150 Boathouse $500 o 1,1 ) <br /> I <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 S <br /> *NOTE:After-the-fact permits(permit squired 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. i j -iC <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: A K 6 it a k�j "I �1•v`'t ck& eat r z <br /> t DI c ' <br /> Property Owner's Mailing Address: 5c 2.. Cali ei'r• 4150 N 1,0 54 �o T p <br /> City State Zip <br /> Property Site Address: 44 2(p 1p O4.ELP 1 �O a� / �otti(o u F 7 l w t SI e 5 Q 5 U <br /> Contact's Telephone Number: 1/5" " 1)'25(4-51 ede, e, <br /> r t i7' a ¢ <br /> Contact's Email: Tht7 N l l�._Al�la C) ) Qf• Lo IM L'L - "i v 1 f 66) o - <br /> 1 l EE <br /> Legal Description of Property: I-0T 4 e-514'l V 41 P9 Z 64 Cloy Lol' 3* NG"far 11 f7 Lbs E <br /> tw -o <br /> Section#: Zr Co Town it: 4 / N Range#: 15 W Town of: 6W 15 S = CO <br /> *Anach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* `, <br /> Tax ID#(1-5 digit number;found on tax statement): a 1 ce 17 0 <br /> po : (..,av kt3I r oN. PX dK.jIe *) `n <br /> Proposed Use of Structure/Addition:diti�oen• > P � -4 <br /> Anticipated <br /> Anticipated Start Date:(3v'&c9 3e.1� WL( ((Home/Cabin;Commercial Blsiness;Bedroom;Deck;etc.) 3 X <br /> Building Contractor: . .2-e.../c.' Sewer Installer: A//A C <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY tt^ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: , ' CPl <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 73 <br /> -N e,�t� �•, hro`� /1 c3( UIS C t "` L '1oti I <br /> (It' 1' "e> ee 1 '.'foc)/'i-S P — P <br /> eioi lfl � <br /> Ce f �� Starve r Vlct . .rte b al 21 Ja x Fee Rec: 2(.b4' <br /> LL ✓tee �w t Abe) St'`! �k G1P. Check#:_594,, <br /> T7 / r <br /> Date of staff site visit: )lo"/(3 I Initials of si e visit staff: }"/v D <br /> APPROVED BY LAND SERVICES OFFICIAL: r,�4 , / I TE: Q7/2.-I < <br /> ff <br /> UPON APPROVAL: APPLICANT ST POST COPY OF a co 03 A <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z <br /> 0 t= <br /> Transcendent: Page 1 of 4 4 <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 < 3'` I' <br /> 7 4) Fill <br /> 6. <br />